Sample records for stage ii-iii esophageal

  1. Docetaxel, cisplatin and 5-fluorouracil adjuvant chemotherapy following three-field lymph node dissection for stage II/III N1, 2 esophageal cancer

    PubMed Central

    HASHIGUCHI, TADASUKE; NASU, MOTOMI; HASHIMOTO, TAKASHI; KUNIYASU, TETSUJI; INOUE, HIROHUMI; SAKAI, NORITAKA; OUCHI, KAZUTOMO; AMANO, TAKAYUKI; ISAYAMA, FUYUMI; TOMITA, NATSUMI; IWANUMA, YOSHIMI; TSURUMARU, MASAHIKO; KAJIYAMA, YOSHIAKI

    2014-01-01

    To determine the efficacy of postoperative adjuvant chemotherapy with docetaxel + cisplatin + 5-fluorouracil (DCF) in lymph node metastasis-positive esophageal cancer, we retrospectively analyzed 139 patients with stage II/III (non-T4) esophageal cancer with lymph node metastasis (1–6 nodes), who did not receive preoperative treatment and underwent three-field lymph node dissection in the Juntendo University Hospital between December, 2004 and December, 2009. The tumors were histologically diagnossed as squamous cell carcinoma. The patients were divided into two groups, a surgery alone group (S group, 88 patients) and a group that received postoperative DCF therapy (DCF group, 51 patients). The disease-free and overall survival were compared between the groups and a multivariate analysis of prognostic factors was performed. The same analysis was performed for cases classified as N1 and N2, according to the TNM classification. There were no significant differences between the S and DCF groups regarding clinicopathological factors other than intramural metastasis and main tumor location. The presence of intramural metastasis, blood vessel invasion and the number of lymph nodes were identified as prognostic factors. The 5-year disease-free and overall survival were 55.8 and 57.3%, respectively, in the S group and 52.8 and 63.0%, respectively, in the DCF group. These differences were not considered to be statistically significant (P=0.789 and 0.479 for disease-free and overall survival, respectively). Although there were no significant differences in disease-free and overall survival between the S and DCF groups in N1 cases, both disease-free and overall survival were found to be better in the DCF group (54.2 and 61.4%, respectively) compared to the S group (29.6 and 28.8%, respectively) in N2 cases (P=0.029 and 0.020 for disease-free and overall survival, respectively). Therefore, postoperative adjuvant chemotherapy with DCF was shown to improve disease-free and overall survival in moderate lymph node metastasis-positive cases (N2), suggesting that the DCF regimen may be effective as postoperative adjuvant chemotherapy for patients with lymph node metastasis from esophageal cancer. PMID:25054036

  2. Esophageal Cancer Staging

    PubMed Central

    Rice, Thomas W.

    2015-01-01

    Accurate staging of esophageal cancer is very important to achieving optimal treatment outcomes. The AJCC (American Joint Committee on Cancer) first published TNM esophageal cancer staging recommendations in the first edition of their staging manual in 1977. Thereafter, the staging of esophageal cancer was changed many times over the years. This article reviews the current status of staging of esophageal cancer. PMID:26078921

  3. Treatment Options by Stage (Esophageal Cancer)

    MedlinePLUS

    ... Treatment (PDQ®) General Information About Esophageal Cancer Key Points Esophageal cancer is a disease in which malignant ( ... NCI Web site . Stages of Esophageal Cancer Key Points After esophageal cancer has been diagnosed, tests are ...

  4. Esophageal cancer: staging system and guidelines for staging and treatment

    PubMed Central

    2014-01-01

    Survival of esophageal cancer is improving but remains poor. Esophageal cancer stage is based on depth of tumor invasion, involvement of regional lymph nodes, and the presence or absence of metastatic disease. Appropriate work-up is critical to identify accurate pre-treatment staging so that both under-treatment and unnecessary treatment is avoided. Treatment strategy should follow guideline recommendations, and generally should be developed after multidisciplinary evaluation. PMID:24876933

  5. [Effect of PSK on recurrence of stage II/III gastric cancer].

    PubMed

    Tanaka, Hiroaki; Muguruma, Kazuya; Kubo, Naoshi; Amano, Ryosuke; Noda, Eiji; Yamada, Nobuya; Yashiro, Masakazu; Maeda, Kiyoshi; Sawada, Tetsuji; Ohira, Masaichi; Ishikawa, Tetsuro; Hirakawa, Kosei

    2010-11-01

    Protein-bound polysaccharide K (PSK) is derived from the CM-101 strain of the fungus Coriolus versicolor. Several clinical studies have demonstrated that PSK has antitumor properties. In Japan, PSK has been used as an adjuvant chemotherapeutic drug against gastric cancer. However, there is little evidence about the effectiveness of PSK in clinical practice. The aim of this study was to evaluate the impact of PSK on postoperative recurrence in patients with gastric cancer. The patients with Stage II/III gastric cancer who underwent a surgical curative resection between 1999 and 2008 at the Department of Surgical Oncology, Osaka City University were included in this retrospective study. All patients received oral fluorinated pyrimidine anti-metabolites with or without PSK after surgical operation. We analyzed clinicopathological features and evaluated the impact of PSK on postoperative recurrence. One hundred thirty eight patients received oral anti-metabolized alone (control group) and 116 patients received PSK (PSK group). No significant difference between control and PSK group in relapse free survival was detected. In PSK group, venous invasion was an independent factor for postoperative recurrence (p=0. 004, HR 1. 538, 95% CI 1. 152 to 2.054). Our results suggested that a population with venous infiltration of primary lesion should be at risk of recurrence after surgery even if PSK was administered as postoperative adjuvant therapy. PMID:21224540

  6. Ultrasonic esophagoprobe for TNM staging of highly stenosing esophageal carcinoma

    Microsoft Academic Search

    Kenneth F. Binmoeller; Hans Seifert; Uwe Seitz; Jakob R. Izbicki; Mitsuhiro Kida; Nib Soehendra

    1995-01-01

    Background: Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor stenoses that cannot be traversed with conventional echoendoscopes. We designed and evaluated a new endosonographic instrument (ultrasonic esophagoprobe) for TNM staging of highly stenosing esophageal carcinomas.Methods: Eighty-seven consecutive patients (64 men, mean age 61 years) with highly stenosing esophageal carcinomas were studied with the

  7. Efficacy of Adjuvant 5-Fluorouracil Therapy for Patients with EMAST-Positive Stage II/III Colorectal Cancer

    PubMed Central

    Hamaya, Yasushi; Guarinos, Carla; Tseng-Rogenski, Stephanie S.; Iwaizumi, Moriya; Das, Ritabrata; Jover, Rodrigo; Castells, Antoni; Llor, Xavier; Andreu, Montserrat; Carethers, John M.

    2015-01-01

    Elevated Microsatellite Alterations at Selected Tetranucleotide repeats (EMAST) is a genetic signature found in up to 60% of colorectal cancers (CRCs) that is caused by somatic dysfunction of the DNA mismatch repair (MMR) protein hMSH3. We have previously shown in vitro that recognition of 5-fluorouracil (5-FU) within DNA and subsequent cytotoxicity was most effective when both hMutS? (hMSH2-hMSH6 heterodimer) and hMutS? (hMSH2-hMSH3 heterodimer) MMR complexes were present, compared to hMutS? > hMutS? alone. We tested if patients with EMAST CRCs (hMutS? defective) had diminished response to adjuvant 5-FU chemotherapy, paralleling in vitro findings. We analyzed 230 patients with stage II/III sporadic colorectal cancers for which we had 5-FU treatment and survival data. Archival DNA was analyzed for EMAST (>2 of 5 markers mutated among UT5037, D8S321, D9S242, D20S82, D20S85 tetranucleotide loci). Kaplan-Meier survival curves were generated and multivariate analysis was used to determine contribution to risk. We identified 102 (44%) EMAST cancers. Ninety-four patients (41%) received adjuvant 5-FU chemotherapy, and median follow-up for all patients was 51 months. Patients with EMAST CRCs demonstrated improved survival with adjuvant 5FU to the same extent as patients with non-EMAST CRCs (P<0.05). We observed no difference in survival between patients with stage II/III EMAST and non-EMAST cancers (P = 0.36). There is improved survival for stage II/III CRC patients after adjuvant 5-FU-based chemotherapy regardless of EMAST status. The loss of contribution of hMSH3 for 5-FU cytotoxicity may not adversely affect patient outcome, contrasting patients whose tumors completely lack DNA MMR function (MSI-H). PMID:25996601

  8. A novel approach to cancer staging: application to esophageal cancer

    PubMed Central

    Blackstone, Eugene H.; Apperson-Hansen, Carolyn; Rice, Thomas W.

    2009-01-01

    A novel 3-step random forests methodology involving survival data (survival forests), ordinal data (multiclass forests), and continuous data (regression forests) is introduced for cancer staging. The methodology is illustrated for esophageal cancer using worldwide esophageal cancer collaboration data involving 4627 patients. PMID:19502615

  9. Role of Postmastectomy Radiation After Neoadjuvant Chemotherapy in Stage II-III Breast Cancer

    SciTech Connect

    Fowble, Barbara L., E-mail: bfowble@radonc.ucsf.edu [Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA (United States); Einck, John P. [Department of Radiation Oncology, University of California, San Diego, CA (United States); Kim, Danny N. [Athena Breast Health Network, Program Management Office, San Francisco, CA (United States); McCloskey, Susan [Department of Radiation Oncology, University of California, Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA (United States); Mayadev, Jyoti [Department of Radiation Oncology, University of California, Davis Cancer Center, Sacramento, CA (United States); Yashar, Catheryn [Department of Radiation Oncology, University of California, San Diego, CA (United States); Chen, Steven L. [Department of Surgery, University of California, Davis Cancer Center, Sacramento, CA (United States); Hwang, E. Shelley [Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA (United States)

    2012-06-01

    Purpose: To identify a cohort of women treated with neoadjuvant chemotherapy and mastectomy for whom postmastectomy radiation therapy (PMRT) may be omitted according to the projected risk of local-regional failure (LRF). Methods and Materials: Seven breast cancer physicians from University of California cancer centers created 14 hypothetical clinical case scenarios, identified, reviewed, and abstracted the available literature (MEDLINE and Cochrane databases), and formulated evidence tables with endpoints of LRF, disease-free survival, and overall survival. Using the American College of Radiology appropriateness criteria methodology, appropriateness ratings for postmastectomy radiation were assigned for each scenario. Finally, an overall summary risk assessment table was developed. Results: Of 24 sources identified, 23 were retrospective studies from single institutions. Consensus on the appropriateness rating, defined as 80% agreement in a category, was achieved for 86% of the cases. Distinct LRF risk categories emerged. Clinical stage II (T1-2N0-1) patients, aged >40 years, estrogen receptor-positive subtype, with pathologic complete response or 0-3 positive nodes without lymphovascular invasion or extracapsular extension, were identified as having {<=}10% risk of LRF without radiation. Limited data support stage IIIA patients with pathologic complete response as being low risk. Conclusions: In the absence of randomized trial results, existing data can be used to guide the use of PMRT in the neoadjuvant chemotherapy setting. Using available studies to inform appropriateness ratings for clinical scenarios, we found a high concordance of treatment recommendations for PMRT and were able to identify a cohort of women with a low risk of LRF without radiation. These low-risk patients will form the basis for future planned studies within University of California Athena Breast Health Network.

  10. Stage II/III rectal cancer with intermediate response to preoperative radiochemotherapy: Do we have indications for individual risk stratification?

    PubMed Central

    2010-01-01

    Background Response to preoperative radiochemotherapy (RCT) in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR) is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT. Methods From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3), treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0) total mesorectal excision (TME) in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS) and overall survival (OS). Results Residual tumor transgression into the mesorectal compartment (ypT3) did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively). Nodal involvement after preoperative RCT (ypN1/2) turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively). Persistent tumor infiltration of the mesorectum (ypT3) and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p < 0.001). Conclusions Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0) resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters. PMID:20388220

  11. Pathologic Factors Associated with Prognosis after Adjuvant Chemotherapy in Stage II/III Microsatellite-Unstable Colorectal Cancers

    PubMed Central

    Kim, Jung Ho; Bae, Jeong Mo; Oh, Hyeon Jeong; Lee, Hye Seung; Kang, Gyeong Hoon

    2015-01-01

    Background: Although there are controversies regarding the benefit of fluoropyrimidine-based adjuvant chemotherapy in patients with microsatellite instability–high (MSI-H) colorectal cancer (CRC), the pathologic features affecting postchemotherapeutic prognosis in these patients have not been fully identified yet. Methods: A total of 26 histopathologic and immunohistochemical factors were comprehensively evaluated in 125 stage II or III MSI-H CRC patients who underwent curative resection followed by fluoropyrimidine-based adjuvant chemotherapy. We statistically analyzed the associations of these factors with disease-free survival (DFS). Results: Using a Kaplan- Meier analysis with log-rank test, we determined that ulceroinfiltrative gross type (p=.003), pT4 (p<.001), pN2 (p=.002), perineural invasion (p=.001), absence of peritumoral lymphoid reaction (p=.041), signet ring cell component (p=.006), and cribriform comedo component (p=.004) were significantly associated with worse DFS in patients receiving oxaliplatin-based adjuvant chemotherapy (n=45). By contrast, pT4 (p<.001) and tumor budding-positivity (p=.032) were significant predictors of poor survival in patients receiving non-oxaliplatin–based adjuvant chemotherapy (n=80). In Cox proportional hazards regression model-based univariate and multivariate analyses, pT category (pT1-3 vs pT4) was the only significant prognostic factor in patients receiving non-oxaliplatin–based adjuvant chemotherapy, whereas pT category, signet ring cell histology and cribriform comedo histology remained independent prognostic factors in patients receiving oxaliplatin-based adjuvant chemotherapy. Conclusions: pT4 status is the most significant pathologic determinant of poor outcome after fluoropyrimidine-based adjuvant chemotherapy in patients with stage II/III MSI-H CRC.

  12. Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer

    ClinicalTrials.gov

    2015-07-09

    Adenocarcinoma of the Gastroesophageal Junction; Esophageal Adenocarcinoma; Stage IB Esophageal Cancer; Stage IIA Esophageal Cancer; Stage IIB Esophageal Cancer; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer

  13. Bevacizumab, Fluorouracil, Leucovorin Calcium, and Oxaliplatin Before Surgery in Treating Patients With Stage II-III Rectal Cancer

    ClinicalTrials.gov

    2014-11-20

    Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Rectum; Stage IIA Rectal Cancer; Stage IIB Rectal Cancer; Stage IIC Rectal Cancer; Stage IIIA Rectal Cancer; Stage IIIB Rectal Cancer; Stage IIIC Rectal Cancer

  14. Fulvestrant and/or Anastrozole in Treating Postmenopausal Patients With Stage II-III Breast Cancer Undergoing Surgery

    ClinicalTrials.gov

    2015-06-19

    Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Recurrent Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

  15. Gene expression profiles at different stages of human esophageal squamous cell carcinoma

    Microsoft Academic Search

    Jin Zhou; Li-Qun Zhao; Mo-Miao Xiong; Xiu-Qin Wang; Guan-Rui Yang; Zong-Liang Qiu; Min Wu; Zhi-Hua Liu

    2003-01-01

    AIM: To characterize the gene expression profiles in different stages of carcinogenesis of esophageal epithelium. METHODS: A microarray containing 588 cancer related genes was employed to study the gene expression profile at different stages of esophageal squamous cell carcinoma including basal cell hyperplasia, high-grade dysplasia, carcinoma in situ, early and late cancer. Principle component analysis was performed to search the

  16. Diet and Physical Activity Change or Usual Care in Improving Survival in Patients With Previously Treated Stage II, III, or IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer | Division of Cancer Prevention

    Cancer.gov

    This randomized phase III trial studies diet and physical activity changes to see how well they work compared with usual care in improving progression-free survival in patients with previously treated stage II, III, or IV ovarian, fallopian tube, or primary peritoneal cancer. A healthy lifestyle and counseling after treatment may improve progression-free survival in patients with previously treated cancer.

  17. Effect of Postmastectomy Radiotherapy in Patients <35 Years Old With Stage II-III Breast Cancer Treated With Doxorubicin-Based Neoadjuvant Chemotherapy and Mastectomy

    SciTech Connect

    Garg, Amit K. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Oh, Julia L. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: joh@mdanderson.org; Oswald, Mary Jane; Huang, Eugene; Strom, Eric A.; Perkins, George H.; Woodward, Wendy A.; Yu, T. Kuan; Tereffe, Welela [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Meric-Bernstam, Funda [Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Hahn, Karin [Department of Breast Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Buchholz, Thomas A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2007-12-01

    Purpose: Postmastectomy radiotherapy (PMRT) improves locoregional control (LRC) in patients with high-risk features after mastectomy. Young age continues to evolve as a potentially important risk factor. The objective of this study was to assess the benefits of PMRT in patients <35 years old treated with doxorubicin-based neoadjuvant chemotherapy for Stage II-III breast cancer. Patients and Methods: We retrospectively analyzed 107 consecutive breast cancer patients <35 years old with Stage IIA-IIIC disease treated at our institution with doxorubicin-based neoadjuvant chemotherapy and mastectomy, with or without PMRT. The treatment groups were compared in terms of LRC and overall survival. Results: Despite more advanced disease stages, the patients who received PMRT (n = 80) had greater rates of LRC (5-year rate, 88% vs. 63%, p = 0.001) and better overall survival (5-year rate, 67% vs. 48%, p = 0.03) than patients who did not receive PMRT (n = 27). Conclusion: Among breast cancer patients <35 years old at diagnosis, the use of PMRT after doxorubicin-based neoadjuvant chemotherapy and mastectomy led to a statistically greater rate of LRC and overall survival compared with patients without PMRT. The benefit seen for PMRT in young patients provides valuable data to better tailor adjuvant, age-specific treatment decisions after mastectomy.

  18. Predictors of timing of adjuvant chemotherapy in older women with hormone receptor–negative, stages II–III breast cancer

    Microsoft Academic Search

    Stephanie B. Wheeler; William R. Carpenter; Jeffrey Peppercorn; Anna P. Schenck; Morris Weinberger; Andrea K. Biddle

    Adherence to consensus guidelines for cancer care may vary widely across health care settings and contribute to differences\\u000a in cancer outcomes. For some women with breast cancer, omission of adjuvant chemotherapy or delays in its initiation may contribute\\u000a to differences in cancer recurrence and mortality. We studied adjuvant chemotherapy use among women with stage II or stage\\u000a III, hormone receptor–negative

  19. Vaccine Therapy and Cyclophosphamide in Treating Patients With Stage II-III Breast or Stage II-IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer

    ClinicalTrials.gov

    2015-06-12

    Recurrent Breast Carcinoma; Recurrent Fallopian Tube Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Primary Peritoneal Carcinoma; Stage IIA Breast Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIB Breast Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIIA Breast Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Primary Peritoneal Cancer; Stage IIIB Breast Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Primary Peritoneal Cancer; Stage IIIC Breast Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Primary Peritoneal Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer

  20. Treatment factors affecting breast cancer-related lymphedema after systemic chemotherapy and radiotherapy in stage II/III breast cancer patients.

    PubMed

    Jung, So-Youn; Shin, Kyung Hwan; Kim, Myungsoo; Chung, Seung Hyun; Lee, Seeyoun; Kang, Han-Sung; Lee, Eun Sook; Kwon, Youngmee; Lee, Keun Seok; Park, In Hae; Ro, Jungsil

    2014-11-01

    We evaluated whether the sequence or regimen of systemic chemotherapy could be a risk factor for breast cancer-related lymphedema (LE). We retrospectively analyzed 848 patients with stage II/III breast cancer who underwent curative surgery with adequate systemic therapy from 2004 to 2009. Adjuvant chemotherapy (ACT) was performed in 552 patients (65.1 %) and neoadjuvant chemotherapy (NAC) in 296 (34.9 %). We evaluated the incidence of LE based on clinicopathological factors and treatments. At a median follow-up of 5.1 years, 358 patients (42.2 %) had experienced LE and 243 (28.7 %) had retained (persistent LE) [120/552 (21.7 %) with ACT vs. 123/296 (41.6 %) with NAC; P < 0.001]. The incidence of LE in patients with taxane was greater than in those without taxane [233/704 (33.1 %) vs. 10/144 (6.9 %); P < 0.001]. Multivariate analysis showed that NAC [hazard ratio (HR), 1.63 in LE event; P < 0.001; HR, 1.39 in persistent LE; P = 0.02] and RT including supraclavicular area (SCRT) (HR 1.55; P = 0.02; HR 1.93; P = 0.006), number of dissected axillary lymph nodes (N-ALNs) >10 (HR, 1.37; P = 0.01; HR, 1.71; P = 0.001), advanced stage (HR, 1.31; P = 0.03; HR, 1.60; P = 0.002), and taxane (HR, 1.69; P = 0.03; HR, 2.07; P = 0.04) were independent risk factors for the LE occurrence. In addition to advanced stage, N-ALNs and SCRT, NAC, and taxane were shown to increase the risk of LE, which could help clinicians identify patients at risk for LE. PMID:25253173

  1. Mastectomy With Immediate Expander-Implant Reconstruction, Adjuvant Chemotherapy, and Radiation for Stage II-III Breast Cancer: Treatment Intervals and Clinical Outcomes

    SciTech Connect

    Wright, Jean L. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Cordeiro, Peter G. [Department of Surgery, Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Ben-Porat, Leah [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Van Zee, Kimberly J. [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Hudis, Clifford [Department of Medicine, Solid Tumor Division, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Beal, Kathryn [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); McCormick, Beryl [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)], E-mail: mccormib@mskcc.org

    2008-01-01

    Purpose: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients. Methods and Materials: Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated. Results: Median age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%. Conclusions: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.

  2. Improvement in Staging of Esophageal Cancer With the Addition of Positron Emission Tomography

    Microsoft Academic Search

    Mark I Block; G. Alexander Patterson; R. Sudhir Sundaresan; Marci S Bailey; Fidelma L Flanagan; Farrokh Dehdashti; Barry A Siegel; Joel D Cooper

    1997-01-01

    Background. Positron emission tomography with the glucose analogue 2-[18F]fluoro-2-deoxy-d-glucose (FDG) has been used to detect and stage a variety of malignancies. We hypothesized that FDG–positron emission tomography would improve staging of patients with esophageal cancer and thereby facilitate selection of candidates for resection.Methods. Fifty-eight patients (42 men and 16 women) with biopsy-proven esophageal cancer were evaluated with both FDG–positron emission

  3. Long-term prognostic and predictive factors in 107 stage II/III breast cancer patients treated with anthracycline-based neoadjuvant chemotherapy.

    PubMed Central

    Brain, E.; Garrino, C.; Misset, J. L.; Carbonero, I. G.; Itzhaki, M.; Cvitkovic, E.; Goldschmidt, E.; Burki, F.; Regensberg, C.; Pappo, E.; Hagipantelli, R.; Musset, M.

    1997-01-01

    The heterogeneity of therapeutic modalities and eligibility criteria and the lack of long-term follow-up in most reports of neoadjuvant chemotherapy for breast cancer preclude us from drawing conclusions about its value in clinically relevant patient subgroups. The present study aims to identify predictive and prognostic factors in 107 non-inflammatory stage II/III breast cancer patients treated between November 1980 and October 1991 with an anthracycline-based induction regimen before locoregional surgery. Preoperative chemotherapy comprised 3-6 cycles of doxorubicin (pirarubicin after 1986), vindesine, cyclophosphamide and 5-fluorouracil. Type of subsequent surgery and adjuvant treatment were decided individually. In analysis of outcome, univariate comparisons of end points were made using the log-rank test, and significant (P < or = 0.05) pre- and post-therapeutic factors were incorporated in a Cox multivariate analysis. With a median follow-up of 81 months (range 32-164+ months), the median disease-free survival (DFS) is 90.5 months while median overall survival has not yet been reached. Cytoprognostic grade and histopathological response in both the primary and lymph nodes were independent covariates associated with locoregional relapse with or without DFS and overall survival. Eleven patients with pathological complete response remain free of disease with a 68-month median follow-up, while the 18 with residual microscopic disease on the specimen showed a 60% cumulative incidence of locoregional recurrence. Despite encouraging response rates based on clinical or radiological evaluation (87% or 70%), neither method showed any significant correlation with pathological response and failed to contribute prognostic information on patients' outcome. Pathological evaluation of antitumoral activity of primary chemotherapy remains a major source of prognostic information and might be used to select patients in need of additional adjuvant treatment. PMID:9155059

  4. Esophagitis

    MedlinePLUS

    ... following increase your risk of esophagitis: Alcohol use Cigarette smoking Surgery or radiation to the chest (for example, treatment for lung cancer) Taking certain medications without plenty of water, especially ...

  5. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

    PubMed Central

    Napier, Kyle J; Scheerer, Mary; Misra, Subhasis

    2014-01-01

    Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide, with a higher incidence in developing nations. With the increased prevalence of gastroesophageal reflux disease and obesity in developed nations, the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the widely accepted TNM system. Staging plays an integral part in guiding stage specific treatment protocols and has a great impact on overall survival. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy mainstays of current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy. PMID:24834141

  6. MTHFR-1298 A>C (rs1801131) is a predictor of survival in two cohorts of stage II/III colorectal cancer patients treated with adjuvant fluoropyrimidine chemotherapy with or without oxaliplatin.

    PubMed

    Cecchin, E; Perrone, G; Nobili, S; Polesel, J; De Mattia, E; Zanusso, C; Petreni, P; Lonardi, S; Pella, N; D'Andrea, M; Errante, D; Rizzolio, F; Mazzei, T; Landini, I; Mini, E; Toffoli, G

    2015-06-01

    Adjuvant treatment based on fluoropyrimidines (FL) improves the prognosis of stage II/III colorectal cancer (CRC). Validated predictive/prognostic biomarkers would spare therapy-related morbidity in patients with a good prognosis. We compared the impact of a set of 22 FL-related polymorphisms with the prognosis of two cohorts of CRC patients treated with adjuvant FL with or without OXA, including a total of 262 cases. 5,10-Methylentetrahydrofolate reductase (MTHFR) MTHFR-1298 A>C (rs1801131) polymorphism had a concordant effect: MTHFR-rs1801131-1298CC genotype carriers had a worse disease free survival (DFS) in both the cohorts. In the pooled population MTHFR-rs1801131-1298CC carriers had also a worse overall survival. We computed a clinical score related to DFS including MTHFR-rs1801131, tumor stage, sex and tumor location, where rs1801131 is the most detrimental factor (hazard ratio=5.3, 95% confidence interval=2.2-12.9; P-value=0.0006). MTHFR-rs1801131 is a prognostic factor that could be used as an additional criteria for the choice of the proper adjuvant regimen in stage II/III colorectal cancer patients. PMID:25331073

  7. Bevacizumab and Intravenous or Intraperitoneal Chemotherapy in Treating Patients With Stage II-III Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer

    ClinicalTrials.gov

    2015-07-09

    Malignant Ovarian Mixed Epithelial Tumor; Ovarian Brenner Tumor; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Cystadenocarcinoma; Ovarian Serous Cystadenocarcinoma; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Primary Peritoneal Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Primary Peritoneal Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Primary Peritoneal Cancer; Undifferentiated Ovarian Carcinoma

  8. General Information about Esophageal Cancer

    MedlinePLUS

    ... Treatment (PDQ®) General Information About Esophageal Cancer Key Points Esophageal cancer is a disease in which malignant ( ... NCI Web site . Stages of Esophageal Cancer Key Points After esophageal cancer has been diagnosed, tests are ...

  9. Pegylated Liposomal Doxorubicin Hydrochloride and Carboplatin Followed by Surgery and Paclitaxel in Treating Patients With Triple Negative Stage II-III Breast Cancer

    ClinicalTrials.gov

    2015-06-10

    Estrogen Receptor-negative Breast Cancer; HER2-negative Breast Cancer; Progesterone Receptor-negative Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Triple-negative Breast Cancer

  10. Treatment results of chemoradiotherapy for clinical stage I (Taman) esophageal carcinoma

    SciTech Connect

    Yamada, Kazunari [Department of Therapeutic Radiology, Tenri Hospital, Nara (Japan)]. E-mail: kyamada-rad@umin.ac.jp; Murakami, Masao [Department of Radiology, Hyogo Ion Beam Center, Hyogo (Japan); Okamoto, Yoshiaki [Department of Radiology, Kobe University Graduate School of Medicine, Kobe (Japan); Okuno, Yoshishige [Department of Therapeutic Radiology, Tenri Hospital, Nara (Japan); Nakajima, Toshifumi [Department of Therapeutic Radiology, Tenri Hospital, Nara (Japan); Kusumi, Fusako [Department of Gastroenterology, Tenri Hospital, Nara (Japan); Takakuwa, Hiroshi [Department of Gastroenterology, Tenri Hospital, Nara (Japan); Matsusue, Satoru [Department of Abdominal Surgery, Tenri Hospital, Nara (Japan)

    2006-03-15

    Purpose: In 1991, we started a clinical prospective trial for operable esophageal carcinoma, foreseeing organ preservation, to assess the treatment results after definitive chemoradiotherapy (Crt) for clinical Stage I (Taman) esophageal cancer. Patients and Methods: Between 1992 and 2003, 63 patients were enrolled in this study. Tumor depth was mucosal cancer (T 1a) in 23 and submucosal cancer (T 1b) in 40. Crt consisted of 55-66 Gy/50-60 fractions (median, 59.4 Gy); from 1 to 3 cycles (median, 2) of concurrent chemotherapy (Cisplatin and 5-fluorouracil), followed by high-dose-rate intraluminal brachytherapy 10-12 Gy/2-3 fractions. Results: The 5-year overall and cause-specific and disease-free survival rates were 66.4%, 76.3%, and 63.7%, respectively. The 5-year cause-specific survival rates for T 1a and T 1b cancer patients were 85.2% and 70.0%, respectively (p = 0.06). The 5-year disease-free survival rates for T 1a and T 1b were 84.4% and 50.5%, respectively (p < 0.01). Esophageal fistula as a late toxicity occurred in 2 patients (G: 1; G: 1), and esophageal stricture requiring a liquid diet occurred in 2 patients. Pericardial effusion was observed in 3 patients. Conclusion: We confirmed that patients with Taman esophageal carcinoma had their esophagus preserved in 89.2% of cases after definitive Crt, and the survival rates were equivalent to those of previous reports of surgery.

  11. 1. : , , I, II, III 2. : .

    E-print Network

    Kim, Yong Jung

    [] KAIST 2011 1 20 1. : , , I, II, III 2. : . · : (MAS109), (MAS212) · : I (MAS241:00­11:30 : · 12:30­14:00 : · 14:30­16:00 : I · 16:30­18:00 : II 1 #12;, 2011.01.20 KAIST : 1. Let A = 1 are orthogonal. 6. Let A = 1 0 0 1 2 0 0 0 3 . Express etA as a matrix, for t R. 2 #12; [] KAIST 2011

  12. 1. : , , I, II, III 2. : .

    E-print Network

    Kim, Yong Jung

    [] KAIST 2011 8 18 1. : , , I, II, III 2. : . · : (MAS109), (MAS212) · : I (MAS241:00­11:30 : · 12:30­14:00 : · 14:30­16:00 : I · 16:30­18:00 : II 1 #12;, 2011.08.18 KAIST : Problem 1 Let M) Prove that A is not diagonalizable. (b) Find the Jordan form of A. 2 #12; [] KAIST 2011 8 18 1

  13. Prognostic impact of clinicopathologic parameters in stage II\\/III breast cancer treated with neoadjuvant docetaxel and doxorubicin chemotherapy: paradoxical features of the triple negative breast cancer

    Microsoft Academic Search

    Bhumsuk Keam; Seock-Ah Im; Hee-Jun Kim; Do-Youn Oh; Jee Hyun Kim; Se-Hoon Lee; Eui Kyu Chie; Wonshik Han; Dong-Wan Kim; Woo Kyung Moon; Tae-You Kim; In Ae Park; Dong-Young Noh; Dae Seog Heo; Sung Whan Ha; Yung-Jue Bang

    2007-01-01

    BACKGROUND: Prognostic factors in locally advanced breast cancer treated with neoadjuvant chemotherapy differ from those of early breast cancer. The purpose of this study was to identify the clinical significance of potential predictive and prognostic factors in breast cancer patients treated by neoadjuvant chemotherapy. METHODS: A total of 145 stage II and III breast cancer patients received neoadjuvant docetaxel\\/doxorubicin chemotherapy

  14. Esophageal actinomycosis in a patient with end-stage renal disease.

    PubMed

    Nagaraju, Shankar Prasad; Kirpalani, Dilip Ashok; Bhabhe, Aditya S; Prasad, Raghvendra; Shah, Hardik; Kirpalani, Ashok L

    2014-04-01

    Actinomycosis of esophagus is uncommon. Herpes simplex virus, cytomegalovirus, candidiasis, tuberculosis, and other fungal infections are the commonly reported infections in both immunocompromised and immunocompetent patients. We report a case of esophageal actinomycosis in an end-stage renal disease patient. A 28-year-old lady, known case of systemic lupus erythematosus, hepatitis B virus infection with end-stage renal disease on regular maintenance hemodialysis since 5 years presented with history of epigastric pain and odynophagia for 1 week. Her upper gastrointestinal endoscopic examination revealed extensive necrotic areas with membrane in the esophagus. Histopathology revealed actinomycotic colonies and bacterial clumps. She was treated with intravenous penicillin followed by oral ampicillin for 6 months. She showed marked clinical improvement, and repeat endoscopy showed healing of ulceration and no evidence of actinomycosis. PMID:24393413

  15. Long-term Survival Outcomes Following Internal Mammary Node Irradiation in Stage II-III Breast Cancer: Results of a Large Retrospective Study With 12-Year Follow-up

    SciTech Connect

    Chang, Jee Suk [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Won [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Yong Bae; Lee, Ik Jae; Keum, Ki Chang; Lee, Chang Geol [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Doo Ho [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Suh, Chang-Ok, E-mail: cosuh317@yuhs.ac [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Huh, Seung Jae, E-mail: sjhuh@smc.samsung.co.kr [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-08-01

    Purpose: To examine the effect of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials: Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results: The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI (P<.001). Otherwise, disease and treatment characteristics were well balanced. The 10-year DFS with and without IMNI was 65% and 57%, respectively (P=.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P=.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively (P=.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions: Internal mammary node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of internal mammary nodes should be considered in postmastectomy radiation therapy.

  16. Lymph node ratio-based staging system for esophageal squamous cell carcinoma

    PubMed Central

    Chen, Shao-Bin; Weng, Hong-Rui; Wang, Geng; Zou, Xiao-Fang; Liu, Di-Tian; Chen, Yu-Ping; Zhang, Hao

    2015-01-01

    AIM: To analyze a modified staging system utilizing lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma (ESCC). METHODS: Clinical data of 2011 patients with ESCC who underwent surgical resection alone between January 1995 and June 2010 at the Cancer Hospital of Shantou University Medical College were reviewed. The LNR, or node ratio (Nr) was defined as the ratio of metastatic LNs ompared to the total number of resected LNs. Overall survival between groups was compared with the log-rank test. The cutoff point of LNR was established by grouping patients with 10% increment in Nr, and then combining the neighborhood survival curves using the log-rank test. A new TNrM staging system, was constructed by replacing the American Joint Committee on Cancer (AJCC) N categories with the Nr categories in the new TNM staging system. The time-dependent receiver operating characteristic curves were used to evaluate the predictive performance of the seventh edition AJCC staging system and the TNrM staging system. RESULTS: The median number of resected LNs was 12 (range: 4-44), and 25% and 75% interquartile rangeswere8 and 16. Patients were classified into four Nr categories with distinctive survival differences (Nr0: LNR = 0; Nr1: 0% < LNR ? 10%; Nr2: 10% < LNR ? 20%; and Nr3: LNR > 20%). From N categories to Nr categories, 557 patients changed their LN stage. The median survival time (MST) for the four Nr categories (Nr0-Nr3) was 155.0 mo, 39.0 mo, 28.0 mo, and 19.0 mo, respectively, and the 5-year overall survival was 61.1%, 41.1%, 33.0%, and 22.9%, respectively (P < 0.001). Overall survival was significantly different for the AJCC N categories when patients were subgrouped into 15 or more vs fewer than 15 examined nodes, except for the N3 category (P = 0.292). However, overall survival was similar when the patients in all four Nr categories were subgrouped into 15 or more vs fewer than 15 nodes. Using the time-dependent receiver operating characteristic, we found that the Nr category and TNrM stage had higher accuracy in predicting survival than the AJCC N category and TNM stage. CONCLUSION: A staging system based on LNR may have better prognostic stratification of patients with ESCC than the current TNM system, especially for those undergoing limited lymphadenectomy.

  17. FOLFOX-6 Induction Chemotherapy Followed by Esophagectomy and Post-operative Chemoradiotherapy in Patients With Esophageal Adenocarcinoma

    ClinicalTrials.gov

    2015-02-16

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Adenocarcinoma of the Gastric Cardia; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer; Stage IIIC Esophageal Cancer

  18. Factors Associated With Severe Acute Esophagitis From Hyperfractionated Radiotherapy With Concurrent Chemotherapy for Limited-Stage Small-Cell Lung Cancer

    SciTech Connect

    Watkins, John M. [Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina (United States); Wahlquist, Amy E. M.S. [Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, South Carolina (United States); Shirai, Keisuke [Department of Medicine, Division of Hematology and Oncology, Medical University of South Carolina, Charleston, South Carolina (United States); Garrett-Mayer, Elizabeth [Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina (United States); Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, Charleston, South Carolina (United States); Aguero, Eric G.; Fortney, John A. [Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina (United States); Sherman, Carol A. [Department of Medicine, Division of Hematology and Oncology, Medical University of South Carolina, Charleston, South Carolina (United States); Sharma, Anand K. [Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina (United States)], E-mail: sharmaak@musc.edu

    2009-07-15

    Purpose: To describe incidence and identify factors associated with development of severe acute esophagitis during hyperfractionated radiotherapy with concurrent chemotherapy (BID-CRT) in patients with limited-stage small-cell lung cancer (SCLC). Methods and Materials: Retrospective cohort analysis of patient-, tumor-, and treatment-related variables was performed to identify factors associated with Radiation Therapy Oncology Group (RTOG) Grade 3 acute esophagitis. Twice-daily chemoradiotherapy (BID-CRT) involved 45 Gy at 1.5 Gy per fraction, treated twice daily with concurrent platinum-based chemotherapy. Logistic regression analyses were used to identify factors associated with esophagitis. Results: Between June 1999 and June 2007, 48 patients underwent curative intent BID-CRT for SCLC and were included in the analysis. Median radiotherapy dose was 45 Gy (range, 42-51 Gy) delivered with a median 4 cycles of chemotherapy (range, 2-6). RTOG Grade 3 acute esophagitis developed in 11 patients. No patient developed Grade 4 or 5 esophagitis. Simple logistic regression analyses demonstrated a highly significant association between Grade 3 acute esophagitis and mean esophageal dose (p = 0.002) as well as relative volume dosimetric area under curve (RV-AUC; p = 0.004). Using multiple regression analysis, RV-AUC was identified as the only factor associated with Grade 3 esophagitis (p = 0.004). The most strongly associated dosimetric volume was the V15 (Grade 3 esophagitis rates of 15% vs. 64% for V15 <60% versus {>=}60%, respectively). Conclusions: RV-AUC is the factor most associated with development of Grade 3 acute esophagitis in limited stage SCLC patients receiving BID-CRT.

  19. Overexpression of CD9 correlates with tumor stage and lymph node metastasis in esophageal squamous cell carcinoma

    PubMed Central

    Huan, Jian; Gao, Yi; Xu, Jing; Sheng, Wenjiong; Zhu, Wei; Zhang, Shuyu; Cao, Jianping; Ji, Jiang; Zhang, Liyuan; Tian, Ye

    2015-01-01

    Objective: Esophageal squamous cell carcinoma (ESCC) is one of the leading causes of cancer deaths worldwide. CD9 has been reported to play a critical role in cell motility, growth and metastasis of multiple cancers. The present study investigated the clinicopathological features of CD9, and its biological characteristics in ESCC. Methods: Fifteen normal esophageal tissue specimens, fifty-three ESCC adjacent tissues and one hundred and four ESCC tissues were included in this study. Using immunohistochemistry (IHC), the expression levels of CD9 were evaluated among different samples. And its clinicopathological parameters and its prognostic factors were analyzed. Western blotting was used to measure CD9 expression and colony formation was performed to determine the effect of CD9 on cell growth in ESCC TE-1 cells. Results: Compared with normal esophageal tissues and tumor adjacent tissues, CD9 expression level is significantly higher in ESCC tissues. CD9 expression correlated with tumor stage (P = 0.022) and lymph node metastasis (P = 0.019) in ESCC patients. Furthermore, the small interfering RNA-mediated silencing of CD9 expression in TE-1 cells resulted in increased proliferation as evidenced by increased colony number and colony size. Conclusion: CD9 expression is upregulated in ESCC tissues and its expression is correlated with tumor stage and lymph node metastasis in ESCC patients. CD9 suppresses the proliferation of TE-1 cells. CD9 may present a potential in tumor progression in ESCC.

  20. Diet and Physical Activity Change or Usual Care in Improving Progression-Free Survival in Patients With Previously Treated Stage II, III, or IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

    ClinicalTrials.gov

    2015-03-17

    Malignant Ovarian Mixed Epithelial Tumor; Ovarian Brenner Tumor; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Cystadenocarcinoma; Ovarian Serous Cystadenocarcinoma; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Primary Peritoneal Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Primary Peritoneal Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Primary Peritoneal Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer; Undifferentiated Ovarian Carcinoma

  1. Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario?

    PubMed Central

    Singh, Sunita; Wakhlu, Ashish; Pandey, Anand; Singh, Anita; Kureel, Shiv N.; Rawat, Jiledar; Srivastava, Payal Mishra

    2012-01-01

    Aims: To analyze whether outcome of neonates having esophageal atresia with or without tracheoesophageal fistula (EA±TEF) associated with anorectal malformation (ARM) can be improved by doing surgery in 2 stages. Materials and Methods: A prospective study of neonates having both EA±TEF and ARM from 2004 to 2011. The patients with favorable parameters were operated in a single stage, whereas others underwent first-stage decompression surgery for ARM. Thereafter, once septicemia was under control and ventilator care available, second-stage surgery for EA±TEF was performed. Results: Total 70 neonates (single stage = 20, 2 stages = 30, expired after colostomy = 9, only EA±TEF repair needed = 11) were enrolled. The admission rate for this association was 1 per 290. Forty-one percent (24/70) neonates had VACTERL association and 8.6% (6/70) neonates had multiple gastrointestinal atresias. Sepsis screen was positive in 71.4% (50/70). The survival was 45% (9/20) in neonates operated in a single stage and 53.3% (16/30) when operated in 2 stages (P = 0.04). Data analysis of 50 patients revealed that the survived neonates had significantly better birth weight, better gestational age, negative sepsis screen, no cardiac diseases, no pneumonia, and 2-stage surgery (P value 0.002, 0.003, 0.02, 0.02, 0.04, and 0.04, respectively). The day of presentation and abdominal distension had no significant effect (P value 0.06 and 0.06, respectively). This was further supported by stepwise logistic regression analysis. Conclusions: In a limited resources scenario, the survival rate of babies with this association can be improved by treating ARM first and then for EA±TEF in second stage, once mechanical ventilator care became available and sepsis was under control. PMID:22869975

  2. Image-Guided Hypofractionated Radiation Therapy With Stereotactic Body Radiation Therapy Boost and Combination Chemotherapy in Treating Patients With Stage II-III Non-Small Cell Lung Cancer That Cannot Be Removed By Surgery

    ClinicalTrials.gov

    2014-12-03

    Adenocarcinoma of the Lung; Adenosquamous Cell Lung Cancer; Large Cell Lung Cancer; Recurrent Non-small Cell Lung Cancer; Squamous Cell Lung Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer

  3. Comparison of the clinical value of multi-band mucosectomy versus endoscopic mucosal resection for the treatment of patients with early-stage esophageal cancer

    PubMed Central

    CHEN, ZI-YANG; YANG, YUN-CHAO; LIU, LI-MEI; LIU, XIAO-GANG; LI, YI; LI, LIANG-PING; HU, XIAO; ZHANG, REN-YI; SONG, YAN; QIN, QIN

    2015-01-01

    The present study aimed to compare the clinical value of multi-band mucosectomy (MBM) versus endoscopic mucosal resection (EMR) for the treatment of patients with early-stage esophageal cancer. Between January 2011 and December 2012, 68 patients with early-stage esophageal cancer who underwent MBM and EMR were enrolled into the present study. The curative resection rate, duration of surgery, complications and follow-up records were retrospectively analyzed. Of the 68 patients included, 33 were treated with MBM and 35 with EMR. There was no significant difference in the rate of complete resection between the MBM and EMR groups (P>0.05). The mean duration of surgery in the MBM group was statistically lower than that in the EMR group (P<0.05). There was no statistically significant difference in the intraoperative and post-operative complications between the MBM and EMR groups (P>0.05). Esophageal cancer reoccurred in 2 patients treated with MBM and 1 patient treated with EMR during the follow-up period (range, 3–24 months). Overall, MBM can be considered a better surgical option for the management of patients with early-stage esophageal cancer, as it offers higher histological curative resection rates and improved safety. However, further studies and a larger follow-up period are required to confirm the long-term curative effect. PMID:26137134

  4. Bevacizumab and Combination Chemotherapy Before Surgery in Treating Patients With Locally Advanced Esophageal or Stomach Cancer

    ClinicalTrials.gov

    2014-03-17

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Squamous Cell Carcinoma of the Esophagus; Stage IA Esophageal Cancer; Stage IA Gastric Cancer; Stage IB Esophageal Cancer; Stage IB Gastric Cancer; Stage IIA Esophageal Cancer; Stage IIA Gastric Cancer; Stage IIB Esophageal Cancer; Stage IIB Gastric Cancer; Stage IIIA Esophageal Cancer; Stage IIIA Gastric Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer

  5. Prognostic Impact of the 6th and 7th American Joint Committee on Cancer TNM Staging Systems on Esophageal Cancer Patients Treated With Chemoradiotherapy

    SciTech Connect

    Nomura, Motoo, E-mail: excell@hkg.odn.ne.jp [Department of Clinical Oncology, Aichi Cancer Center Hospital (Japan); Department of Radiation Oncology, Aichi Cancer Center Hospital (Japan); Shitara, Kohei [Department of Clinical Oncology, Aichi Cancer Center Hospital (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center Hospital (Japan); Hatooka, Shunzo [Department of Thoracic Surgery, Aichi Cancer Center Hospital (Japan); Mizota, Ayako; Kondoh, Chihiro; Yokota, Tomoya; Takahari, Daisuke; Ura, Takashi; Muro, Kei [Department of Clinical Oncology, Aichi Cancer Center Hospital (Japan)

    2012-02-01

    Purpose: The new 7th edition of the American Joint Committee on Cancer TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. There is no information available on evaluation of the new staging system with regard to prognosis of patients treated with chemoradiotherapy (CRT). The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal cancer patients treated with CRT. Methods and Materials: A retrospective review was performed on 301 consecutive esophageal squamous cell carcinoma patients treated with CRT. Comparisons were made of the prognostic impacts of the 6th and 7th staging systems and the prognostic impacts of stage and prognostic groups, which were newly defined in the 7th edition. Results: There were significant differences between Stages I and III (p < 0.01) according to both editions. However, the 7th edition poorly distinguishes the prognoses of Stages III and IV (p = 0.36 by multivariate analysis) in comparison to the 6th edition (p = 0.08 by multivariate analysis), although these differences were not significant. For all patients, T, M, and gender were independent prognostic factors by multivariate analysis (p < 0.05). For the Stage I and II prognostic groups, survival curves showed a stepwise decrease with increase in stage, except for Stage IIA. However, there were no significant differences seen between each prognostic stage. Conclusions: Our study indicates there are several problems with the 7th TNM staging system regarding prognostic factors in patients undergoing CRT.

  6. Radiation esophagitis.

    PubMed

    Murro, Diana; Jakate, Shriram

    2015-06-01

    The esophagus is frequently exposed to radiation during treatment of advanced stages of common cancers such as lung, breast, and esophagus. However, symptomatic radiation esophagitis requiring endoscopic and histologic evaluation occurs quite rarely, affecting less than 1% of patients receiving radiation treatment. Symptoms occur acutely, generally within the first 2 months. Patients typically present with nonspecific symptoms such as dysphagia and odynophagia. Endoscopic changes such as erythema and ulceration are also nonspecific and nondiagnostic. Biopsies from affected areas show variable inflammatory changes and radiation-related atypia of endothelial and stromal cells. Such atypia mimics cytomegalovirus cytopathic changes, which are ruled out through absence of immunostaining. Radiation esophagitis is thus clinically unsuspected and endoscopically and histologically quite different from the more common and familiar radiation proctitis for which angioectasia is the predominant finding. PMID:26030254

  7. [Stage IV small cell esophageal carcinoma that responded to various chemotherapeutic regimens with relative longevity - a case report].

    PubMed

    Yamakoshi, Yoshihito; Kubo, Naoshi; Ohira, Masaichi; Sakurai, Katsunobu; Toyokawa, Takahiro; Shibutani, Masatsune; Yamazoe, Sadaaki; Nagahara, Hisashi; Kimura, Kenjiro; Amano, Ryosuke; Tanaka, Hiroaki; Muguruma, Kazuya; Ohtani, Hiroshi; Yashiro, Masakazu; Maeda, Kiyoshi; Hirakawa, Kosei

    2014-11-01

    Small cell carcinoma of the esophagus is reported to be both rare and aggressive, and is commonly associated with a short post-diagnosis survival period. We report a case of Stage IV small cell carcinoma of the esophagus involving a relatively long survival period of 2 years. The patient was a 70-year-old man with a chief complaint of epigastric discomfort. Upper gastrointestinal endoscopy by a local physician showed a protruding tumor at the mid-thoracic esophagus. Tumor biopsy revealed small cell carcinoma. Chest-abdominal computed tomography revealed multiple liver metastases, and swelling of a number of regional lymph nodes. The diagnosis was cT3N4M1, cStage IVb esophageal small cell carcinoma. According to the regimen used for lung small cell carcinoma, we administered CDDP/CPT-11. After administration of four courses, the primary lesion, liver metastases, and lymph node metastases significantly reduced, indicating a partial response. However, after completion of eight courses, liver metastasis and lymph node swelling recurred. The patient subsequently received other therapeutic regimens such as CBDCA/VP-16, AMR, NGT, and CDGP/5-FU. However, the tumor gradually progressed, and the patient died approximately 2 years after the first treatment. PMID:25731409

  8. C-Met Inhibitor AMG 337, Oxaliplatin, Leucovorin Calcium, and Fluorouracil in Treating Patients With Advanced Stomach or Esophageal Cancer

    ClinicalTrials.gov

    2015-01-16

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Gastrointestinal Cancer; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Stage IIIA Esophageal Cancer; Stage IIIA Gastric Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

  9. Detection of Synchronous Cancers by Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography during Primary Staging Workup for Esophageal Squamous Cell Carcinoma in Taiwan

    PubMed Central

    Chen, Shih-Hsin; Chan, Sheng-Chieh; Chao, Yin-Kai; Yen, Tzu-Chen

    2013-01-01

    Aim The aim of this retrospective study was to investigate the ability of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the detection of synchronous cancers during staging workup for esophageal squamous cell carcinoma. Materials and Methods We performed a retrospective chart review of 426 Taiwanese patients with esophageal cancer who received FDG-PET/CT during their primary staging workup between December 2006 and December 2011. We defined synchronous cancers as those occurring within 6 months of the FDG-PET/CT scan. All of the synchronous lesions were confirmed by histology or imaging follow-up. The study patients were followed for at least 18 months or were censored on the date of last follow-up. Results Fifty patients were excluded from analysis because of the presence of distant metastases. Of the remaining 376 patients, 359 were diagnosed with squamous cell carcinoma (SCC). We identified 17 patients with synchronous cancers, and all of them had a diagnosis of SCC. Synchronous head and neck cancers were the most frequent (n=13, 76.4%), followed by gastrointestinal cancers (colon cancer, n=2; hepatocellular carcinoma, n=1), and renal cell carcinoma (n=1). FDG-PET/CT successfully detected 15 synchronous cancers (12 head and neck cancers, 2 colon cancers, and 1 renal cell carcinoma). In contrast, conventional workup detected only 9 synchronous cancers (7 head and neck cancers, 1 hepatocellular carcinoma and 1 renal cell carcinoma). The sensitivity of FDG-PET/CT and conventional workup in detecting synchronous cancers were 88.2% and 52.9% respectively. Conclusion The most frequent synchronous lesions in patients with esophageal SCC were head and neck cancers in Taiwan. Our data indicate that FDG-PET/CT is superior to conventional workup in the detection of synchronous tumors during primary staging for esophageal squamous cell carcinoma. PMID:24312435

  10. Risk of node metastasis of sentinel lymph nodes detected in level II/III of the axilla by single-photon emission computed tomography/computed tomography

    PubMed Central

    SHIMA, HIROAKI; KUTOMI, GORO; SATOMI, FUKINO; MAEDA, HIDEKI; TAKAMARU, TOMOKO; KAMESHIMA, HIDEKAZU; OMURA, TOSEI; MORI, MITSURU; HATAKENAKA, MASAMITSU; HASEGAWA, TADASHI; HIRATA, KOICHI

    2014-01-01

    In breast cancer, single-photon emission computed tomography/computed tomography (SPECT/CT) shows the exact anatomical location of sentinel nodes (SN). SPECT/CT mainly exposes axilla and partly exposes atypical sites of extra-axillary lymphatic drainage. The mechanism of how the atypical hot nodes are involved in lymphatic metastasis was retrospectively investigated in the present study, particularly at the level II/III region. SPECT/CT was performed in 92 clinical stage 0-IIA breast cancer patients. Sentinel lymph nodes are depicted as hot nodes in SPECT/CT. Patients were divided into two groups: With or without hot node in level II/III on SPECT/CT. The existence of metastasis in level II/III was investigated and the risk factors were identified. A total of 12 patients were sentinel lymph node biopsy metastasis positive and axillary lymph node dissection (ALND) was performed. These patients were divided into two groups: With and without SN in level II/III, and nodes in level II/III were pathologically proven. In 11 of the 92 patients, hot nodes were detected in level II/III. There was a significant difference in node metastasis depending on whether there were hot nodes in level II/III (P=0.0319). Multivariate analysis indicated that the hot nodes in level II/III and lymphatic invasion were independent factors associated with node metastasis. There were 12 SN-positive patients followed by ALND. In four of the 12 patients, hot nodes were observed in level II/III. Two of the four patients with hot nodes depicted by SPECT/CT and metastatic nodes were pathologically evident in the same lesion. Therefore, the present study indicated that the hot node in level II/III as depicted by SPECT/CT may be a risk of SN metastasis, including deeper nodes. PMID:25289038

  11. Multi-susceptibility genes associated with the risk of the development stages of esophageal squamous cell cancer in Feicheng County

    PubMed Central

    2011-01-01

    Background The purpose of this study was to evaluate the association of multi-genotype polymorphisms with the stepwise progression of esophageal squamous cell cancer (ESCC) and the possibility of predicting those at higher risk. Methods A total of 1,004 subjects were recruited from Feicheng County, China, between Jan. 2004 and Dec. 2007 and examined by endoscopy for esophageal lesions. These subjects included 270 patients with basal cell hyperplasia (BCH), 262 patients with esophageal squamous cell dysplasia (ESCD), 226 patients with ESCC, and 246 controls with Lugol-voiding area but diagnosed as having normal esophageal squamous epithelial cells by histopathology. The genotypes for CYP2E1 G1259C, hOGG1 C326G, MTHFR C677T, MPO G463A, and ALDH2 allele genes were identified in blood samples collected from all participants. Results The alleles ALDH2 and MTHFR C677T were critical for determining individual susceptibility to esophageal cancer. Compared to the ALDH 1*1 genotype, the ALDH 2*2 genotype was significantly associated with increased risks of BCH, ESCD, and ESCC. However, the TT genotype of MTHFR C677T only increased the risk of ESCC. Further analysis revealed that the combination of the high-risk genotypes 2*2/1*2 of ALDH 2 and TT/TC of MTHFR C677T increased the risk of BCH by 4.0 fold, of ESCD by 3.7 fold, and ESSC by 8.72 fold. The generalized odds ratio (ORG) of the two combined genotypes was 1.83 (95%CI: 1.55-2.16), indicating a strong genetic association with the risk of carcinogenic progression in the esophagus. Conclusions The study demonstrated that the genotypes ALDH2*2 and MTHFR 677TT conferred elevated risk for developing esophageal carcinoma and that the two susceptibility genotypes combined to synergistically increase the risk. PMID:21672255

  12. Esophageal spasm

    MedlinePLUS

    Diffuse esophageal spasm; Spasm of the esophagus; Distal esophageal spasm ... Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap ...

  13. Candida esophagitis

    Microsoft Academic Search

    Robert Mathieson; Sudhir K. Dutta

    1983-01-01

    Summary Candida esophagitis is being increasingly recognized in the practice of clinical gastroenterology. The widespread use of corticosteroids, immunosuppressive drugs, and cancer chemotherapy, combined with the frequent use of endoscopy for the evaluation of esophageal symptoms, often leads to the identification ofCandida infection in this part of the gastrointestinal tract. The salient clinical features ofCandida esophagitis include odynophagia and dysphagia,

  14. Endoscopic ultrasound for esophageal and gastroesophageal junction cancer: Impact of increased use of primary neoadjuvant therapy on preoperative locoregional staging accuracy.

    PubMed

    DeWitt, J; Kesler, K; Brooks, J A; LeBlanc, J; McHenry, L; McGreevy, K; Sherman, S

    2005-01-01

    Initial treatment of locally advanced esophageal and gastroesophageal junction (GEJ) malignancies for selected patients at some institutions has recently changed from surgical resection to neoadjuvant therapy. The aim of this study is to evaluate the impact of this change in treatment strategy on both the overall disease profile and locoregional endoscopic ultrasound (EUS) staging accuracy for a cohort of patients managed with primary surgical resection over a 10-year period at our institution. All subjects at our institution who underwent primary esophagectomy from 1993 to 2002 following preoperative EUS for known or suspected esophageal and/or GEJ cancers were identified. Patients with dysplasia alone, prior upper gastrointestinal tract surgery, preoperative neoadjuvant therapy, cancer of the gastric cardia or recurrent malignancy were excluded. EUS findings and staging results were compared to surgical pathology following resection. The impact of the gradually increased use of primary chemoradiation during the second half of the study was assessed. Of the 286 operations performed, 184 subjects were excluded. The remaining 102 underwent primary surgical resection a median of 18 days following EUS staging for adenocarcinoma (88%) or squamous cell carcinoma (12%) of the esophagus (69%) or GEJ (31%). Overall EUS locoregional T and N staging accuracy was 72% and 75% respectively; accuracy for T1, T2, T3 and T4 cancer was 42%, 50%, 88% and 50% respectively. Despite an increased frequency of pathologically confirmed T1 and T2 cancers (P = 0.005) and an insignificant trend toward increased N0 malignancy (P = 0.05) during the second half of the study period, no statistically significant changes in T (P = 0.07) or N (P = 0.82) staging accuracies for EUS or disease characteristics were noted between the first and second half of the study period. Despite both inaccurate radial EUS staging and increased relative use of primary surgery for early cancers, recent increased use of primary neoadjuvant therapy did not change overall disease characteristics and accuracy of locoregional EUS staging of esophageal and GEJ cancers managed with primary surgical resection. PMID:15773837

  15. Herpetic esophagitis

    SciTech Connect

    Shortsleeve, M.J.; Gauvin, G.P.; Gardner, R.C.; Greenberg, M.S.

    1981-12-01

    Four patients with herpetic esophagitis were examined. In three of them, the presenting symptom was odynophagia. Early in the course of herpetic esophagitis, shallow round and oval ulcers were seen on barium esophagograms. Later, the ulcers filled with fibrinous exudate, forming nodular plaques that projected into the esophageal lumen. Although these findings are diagnostic of esophagitis, they are not specific for a herpes virus infection. The definitive diagnosis must be established by histologic examination, which demonstrates the cytopathic effect of the herpes virus infection within the squamous epithelium.

  16. Esophageal Stenosis Associated With Tumor Regression in Radiotherapy for Esophageal Cancer: Frequency and Prediction

    SciTech Connect

    Atsumi, Kazushige [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Arimura, Hidetaka [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Terashima, Kotaro [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Matsuki, Takaomi [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Tsurumaru, Daisuke; Ohnishi, Kayoko; Asai, Kaori; Matsumoto, Keiji [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

    2012-04-01

    Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer.

  17. Caustic ingestion and esophageal function

    SciTech Connect

    Cadranel, S.; Di Lorenzo, C.; Rodesch, P.; Piepsz, A.; Ham, H.R. (Children University Hospital, Brussels (Belgium))

    1990-02-01

    The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

  18. Proton Beam Therapy and concurrent chemotherapy for esophageal cancer

    PubMed Central

    Lin, Steven H.; Komaki, Ritsuko; Liao, Zhongxing; Wei, Caimiao; Myles, Bevan; Guo, Xiaomao; Palmer, Matthew; Mohan, Radhe; Swisher, Stephen G.; Hofstetter, Wayne L.; Ajani, Jaffer A.; Cox, James D.

    2014-01-01

    Purpose/Objective Proton beam therapy (PBT) is a promising modality for the management of thoracic malignancies. We report our preliminary experience of treating esophageal cancer patients with concurrent chemotherapy (CChT) and PBT at MD Anderson Cancer Center. Materials/Methods This is an analysis of 62 esophageal cancer patients enrolled on a prospective study evaluating normal tissue toxicity from CChT/PBT from 2006 to 2010. Patients were treated with Passive Scattering PBT with 2 or 3 field beam arrangement using 180–250 MV protons. We used the method of Kaplan and Meier to assess time to event outcomes and compared the distributions between groups using the log-rank test. Results The median follow-up time was 20.1 months for survivors. The median age was 68 years (range 38–86). Most were males (82%), had adenocarcinomas (76%) and had stage II-III disease (84%). The median radiation dose was 50.4 Gray-Equivalence (Gy(RBE)) (range 36–57.6). The most common grade 2–3 acute toxicities from CChT/PBT were esophagitis (46.8%), fatigue (43.6%), nausea (33.9%), anorexia (30.1%), and radiation dermatitis (16.1%). There were two cases of grade 2 and 3 radiation pneumonitis and two grade 5 toxicities. A total of 29 patients (46.8%) received preoperative CChT/PBT with one postoperative death. The pathologic complete response (pCR) rate for the surgical cohort was 28%, and the pCR and near CR rate (0–1% residual cells) was 50%. While there were significantly fewer local-regional recurrences in the preoperative group (3/29) as compared to the definitive CChT/PBT group (16/33) (log-rank test p=0.005), there were no differences in DM free interval or OS between the two groups. Conclusions This is the first report of patients treated with PBT/CChT for esophageal cancer. Our data suggest that this modality is associated with a few severe toxicities but the pathologic response and clinical outcomes are encouraging. Prospective comparison with more traditional approach is warranted. PMID:22417808

  19. Pralatrexate and Oxaliplatin in Treating Patients With Unresectable or Metastatic Esophageal, Stomach, or Gastroesophageal Junction Cancer

    ClinicalTrials.gov

    2015-03-05

    Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Esophageal Cancer; Recurrent Gastric Cancer; Squamous Cell Carcinoma of the Esophagus; Stage III Esophageal Cancer; Stage III Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

  20. Esophageal actinomycosis

    Microsoft Academic Search

    Fu-Tsan Chou; Ken-Sheng Cheng; I-Ping Chiang

    2006-01-01

    Esophageal actinomycosis is uncommon and has been reported in immunocompetent and immunocompromised patients. A 41-y-old man\\u000a with a history of heavy alcohol use presented with progressively worsening odynophagia and dysphagia over a 2-wk period. Upper\\u000a gastrointestinal endoscopy and esophageal biopsy revealed ulceration withActinomyces and candidal infection. After therapy with intravenous penicillin G followed by oral amoxicillin that led to clinical

  1. Infectious esophagitis

    Microsoft Academic Search

    Brian P. Mulhall; Roy K. H. Wong

    2003-01-01

    Opinion statement  Infectious esophagitis can have significant implications in an impaired host. Described most commonly in immunocompromised\\u000a patients, infectious esophagitis can also occasionally be discovered in immunocompetent individuals in several unique clinical\\u000a settings. Evaluation of the typical presenting complaints, such as dysphagia or odynophagia, are especially important in immunocompetent\\u000a patients, and therapy should be directed at the appropriate predisposing condition and

  2. Esophageal Microbiome in Eosinophilic Esophagitis

    PubMed Central

    Harris, J. Kirk; Fang, Rui; Wagner, Brandie D.; Choe, Ha Na; Kelly, Caleb J.; Schroeder, Shauna; Moore, Wendy; Stevens, Mark J.; Yeckes, Alyson; Amsden, Katie; Kagalwalla, Amir F.; Zalewski, Angelika; Hirano, Ikuo; Gonsalves, Nirmala; Henry, Lauren N.; Masterson, Joanne C.; Robertson, Charles E.; Leung, Donald Y.; Pace, Norman R.; Ackerman, Steven J.; Furuta, Glenn T.; Fillon, Sophie A.

    2015-01-01

    Objective The microbiome has been implicated in the pathogenesis of a number of allergic and inflammatory diseases. The mucosa affected by eosinophilic esophagitis (EoE) is composed of a stratified squamous epithelia and contains intraepithelial eosinophils. To date, no studies have identified the esophageal microbiome in patients with EoE or the impact of treatment on these organisms. The aim of this study was to identify the esophageal microbiome in EoE and determine whether treatments change this profile. We hypothesized that clinically relevant alterations in bacterial populations are present in different forms of esophagitis. Design In this prospective study, secretions from the esophageal mucosa were collected from children and adults with EoE, Gastroesophageal Reflux Disease (GERD) and normal mucosa using the Esophageal String Test (EST). Bacterial load was determined using quantitative PCR. Bacterial communities, determined by 16S rRNA gene amplification and 454 pyrosequencing, were compared between health and disease. Results Samples from a total of 70 children and adult subjects were examined. Bacterial load was increased in both EoE and GERD relative to normal subjects. In subjects with EoE, load was increased regardless of treatment status or degree of mucosal eosinophilia compared with normal. Haemophilus was significantly increased in untreated EoE subjects as compared with normal subjects. Streptococcus was decreased in GERD subjects on proton pump inhibition as compared with normal subjects. Conclusions Diseases associated with mucosal eosinophilia are characterized by a different microbiome from that found in the normal mucosa. Microbiota may contribute to esophageal inflammation in EoE and GERD. PMID:26020633

  3. [Eosinophilic esophagitis].

    PubMed

    Kusunose, Hiroaki; Ohara, Shuichi

    2015-07-01

    Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. Because of elevated total IgE levels and high rates of concurrent allergic diseases compared with the general population, EoE appears to be an antigen-driven immunologic process that caused by allergens like food or aeroallergens. EoE is a disease that features dense intraepithelial infiltration by eosinophils which cause excessive mucosal immunologic reactions which cause several symptoms that mostly involve dysphagia. For establishment of the diagnosis, infiltration of eosinophils (? 20 eosinophils/HPF) should be identified in an esophageal mucosal biopsy specimen. In treatment of patients have a possibility of EoE, proton-pump inhibitors(PPIs) must be tried as first choice. Other proved therapeutic options include topical or systemic corticosteroids, chronic dietary elimination, and esophageal dilation, but local administration of glucocorticoids has recently been reported as useful therapy for EoE. PMID:26165084

  4. Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

    PubMed Central

    Chen, Hai-yan; Ma, Xiu-mei; Ye, Ming; Hou, Yan-li; Xie, Hua-Ying; Bai, Yong-rui

    2014-01-01

    The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0–3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ?70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose >100 Gy (biologically effective dose?10), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor. PMID:24914102

  5. Snapshot of Esophageal Cancer

    MedlinePLUS

    ... Discovery A Snapshot of Esophageal Cancer Incidence and Mortality Esophageal cancer consists of two primary cancer types, ... ethnic groups have higher esophageal cancer incidence and mortality rates than women. Historically, African American men have ...

  6. Surgical Management of Esophageal Carcinoma

    Microsoft Academic Search

    CAROLYN E. REED

    Surgical management of esophageal carcinoma is reviewed. The anatomy and biology are briefly mentioned, since these factors mitigate against the success of surgery. Staging, the key to proper treatment allocation and prog- nosis, is discussed, including the use of endoscopic ultra- sonography, positron emission tomography, and thoracoscopy\\/laparoscopy. Patient selection and preparation for surgery are important considerations. Surgical tech- niques are

  7. 40 CFR 146.10 - Plugging and abandoning Class I, II, III, IV, and V wells.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...abandoning Class I, II, III, IV, and V wells. 146.10 Section 146.10 Protection...abandoning Class I, II, III, IV, and V wells. (a) Requirements for Class I, II and III wells. (1) Prior to abandoning Class I, II...

  8. 40 CFR 146.10 - Plugging and abandoning Class I, II, III, IV, and V wells.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...abandoning Class I, II, III, IV, and V wells. 146.10 Section 146.10 Protection...abandoning Class I, II, III, IV, and V wells. (a) Requirements for Class I, II and III wells. (1) Prior to abandoning Class I, II...

  9. 40 CFR 146.10 - Plugging and abandoning Class I, II, III, IV, and V wells.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...abandoning Class I, II, III, IV, and V wells. 146.10 Section 146.10 Protection...abandoning Class I, II, III, IV, and V wells. (a) Requirements for Class I, II and III wells. (1) Prior to abandoning Class I, II...

  10. 40 CFR 146.10 - Plugging and abandoning Class I, II, III, IV, and V wells.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...abandoning Class I, II, III, IV, and V wells. 146.10 Section 146.10 Protection...abandoning Class I, II, III, IV, and V wells. (a) Requirements for Class I, II and III wells. (1) Prior to abandoning Class I, II...

  11. 40 CFR 146.10 - Plugging and abandoning Class I, II, III, IV, and V wells.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...abandoning Class I, II, III, IV, and V wells. 146.10 Section 146.10 Protection...abandoning Class I, II, III, IV, and V wells. (a) Requirements for Class I, II and III wells. (1) Prior to abandoning Class I, II...

  12. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).

    PubMed

    Vilmann, Peter; Frost Clementsen, Paul; Colella, Sara; Siemsen, Mette; De Leyn, Paul; Dumonceau, Jean-Marc; Herth, Felix J; Larghi, Alberto; Vazquez-Sequeiros, Enrique; Hassan, Cesare; Crombag, Laurence; Korevaar, Daniël A; Konge, Lars; Annema, Jouke T

    2015-07-01

    This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and esophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence.The article has been co-published with permission in Endoscopy and the European Respiratory Journal. PMID:26034060

  13. ARSENIC INTERACTION WITH IRON (II, III) HYDROXYCARBONATE GREEN RUST: IMPLICATIONS FOR ARSENIC REMEDIATION

    EPA Science Inventory

    Zerovalent iron is being used in permeable reactive barriers (PRBs) to remediate groundwater arsenic contamination. Iron(II, III) hydroxycarbonate green rust is a major corrosion product of zerovalent iron under anaerobic conditions. The interaction between arsenic and this green...

  14. Esophageal stricture - benign

    MedlinePLUS

    ... stricture can be caused by: Gastroesophageal reflux (GERD) Eosinophilic esophagitis Injuries caused by an endoscope Long-term use ... returning. Surgery is rarely needed. If you have eosinophilic esophagitis, you may need to take medicines or make ...

  15. Esophageal tuberculosis mimicking malignancy.

    PubMed

    Geusens, E; Verschakelen, J A; Flamaing, J; Bogaert, J; Ponette, E; Decramer, M; Baert, A L

    1996-01-01

    A case of pulmonary and esophageal tuberculosis in an 82-year-old female is presented. Esophageal tuberculosis is very rarely seen in Europe and the United States, but the disease is still endemic in India. The major differential diagnosis is esophageal malignancy. Findings that can suggest the diagnosis are tracheo-esophageal fistula formation, enlarged, centrally necrotizing lymph nodes, and a micronodular lung pattern. PMID:8797957

  16. Genes Regulating Epithelial Polarity Are Critical Suppressors of Esophageal Oncogenesis

    PubMed Central

    Li, Xiu-Min; Wang, Hui; Zhu, Li-Li; Zhao, Run-Zhen; Ji, Hong-Long

    2015-01-01

    Esophageal cancer is an aggressive disease featured by early lymphatic and hematogenous dissemination, and is the sixth leading cause of cancer-related deaths worldwide. The proper formation of apicobasal polarity is essential for normal epithelium physiology and tissue homeostasis, while loss of polarity is a hallmark of cancer development including esophageal oncogenesis. In this review, we summarized the stages of esophageal cancer development associated with the loss or deregulation of epithelial cell apicobasal polarity. Loss of epithelial apicobasal polarity exerts an indispensable role in the initiation of esophageal oncogenesis, tumor progression, and the advancement of tumors from benign to malignant. In particular, we reviewed the involvement of several critical genes, including Lkb1, claudin-4, claudin-7, Par3, Lgl1, E-cadherin, and the Scnn1 gene family. Understanding the role of apicobasal regulators may lead to new paradigms for treatment of esophageal tumors, including improvement of prognostication, early diagnosis, and individually tailored therapeutic interventions in esophageal oncology. PMID:26185530

  17. Multiple esophageal rings: an association with eosinophilic esophagitis

    Microsoft Academic Search

    Constantinos G Siafakas; Charlotte K Ryan; Marilyn R Brown; Tracie L Miller

    2000-01-01

    Esophagitis may present endoscopically with erythema, edema, loss of vascular pattern, friability, and ulceration of the esophageal mucosa. Left untreated, chronic esophagitis may result in stricture formation. The presence of multiple concentric rings involving the entire esophagus has been cited as a chronic form of esophagitis. We present a case of an 8-yr-old boy with multiple concentric esophageal rings and

  18. [Esophageal motility disorders].

    PubMed

    Müller, M; Gockel, I

    2015-06-01

    Esophageal motility disorders are a group of diseases that result in swallowing dysfunction due to changes in neuromuscular structures, which coordinate esophageal function. Besides achalasia, which is the best defined functional disturbance of the esophagus, there are other motility disorders, namely hypercontractile (diffuse esophageal spasm, nutcracker or jackhammer esophagus, hypertensive lower esophageal sphincter) and hypocontractile disorders, whose origins and disease mechanisms are not yet well understood. The main symptoms are dysphagia and thoracic pain. Diagnosis is usually made by means of esophageal manometry, while endoscopy and barium swallow are essential to exclude inflammatory or neoplastic changes. The introduction of high resolution manometry (HRM) with up to 36 pressure points that are simultaneously measured on the esophageal catheter has changed diagnosis and assessment, and has led-with the Chicago Classification-to a new functional classification of esophageal motility disorders. In the following review, the most important motility disorders of the esophagus are introduced. PMID:25940142

  19. A Molecular Predictor Reassesses Classification of Human Grade II/III Gliomas

    PubMed Central

    Rème, Thierry; Bièche, Ivan; Rigau, Valérie; Burel-Vandenbos, Fanny; Prévot, Vincent; Baroncini, Marc; Fontaine, Denys; Chevassus, Hugues; Vacher, Sophie; Lidereau, Rosette; Duffau, Hugues

    2013-01-01

    Diffuse gliomas are incurable brain tumors divided in 3 WHO grades (II; III; IV) based on histological criteria. Grade II/III gliomas are clinically very heterogeneous and their prognosis somewhat unpredictable, preventing definition of appropriate treatment. On a cohort of 65 grade II/III glioma patients, a QPCR-based approach allowed selection of a biologically relevant gene list from which a gene signature significantly correlated to overall survival was extracted. This signature clustered the training cohort into two classes of low and high risk of progression and death, and similarly clustered two external independent test cohorts of 104 and 73 grade II/III patients. A 22-gene class predictor of the training clusters optimally distinguished poor from good prognosis patients (median survival of 13–20 months versus over 6 years) in the validation cohorts. This classification was stronger at predicting outcome than the WHO grade II/III classification (P?2.8E-10 versus 0.018). When compared to other prognosis factors (histological subtype and genetic abnormalities) in a multivariate analysis, the 22-gene predictor remained significantly associated with overall survival. Early prediction of high risk patients (3% of WHO grade II), and low risk patients (29% of WHO grade III) in clinical routine will allow the development of more appropriate follow-up and treatments. PMID:23805239

  20. Staging of neoplasms

    SciTech Connect

    Glazer, G.M.

    1986-01-01

    This book contains 10 chapters and 10 case studies. Some of the chapter titles are: Metastatic Disease to the Thorax, CT Staging of Esophageal Carcinoma, CT Staging of Renal Carcinoma, CT Staging of Lymphoma, Staging of Non-Small Cell Lung Cancer, and Initital Experience with MRI Staging of Neoplasms.

  1. Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).

    PubMed

    Vilmann, Peter; Clementsen, Paul Frost; Colella, Sara; Siemsen, Mette; De Leyn, Paul; Dumonceau, Jean-Marc; Herth, Felix J; Larghi, Alberto; Vasquez-Sequeiros, Enrique; Hassan, Cesare; Crombag, Laurence; Korevaar, Daniël A; Konge, Lars; Annema, Jouke T

    2015-06-01

    This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE), produced in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). It addresses the benefit and burden associated with combined endobronchial and esophageal mediastinal nodal staging of lung cancer. The Scottish Intercollegiate Guidelines Network (SIGN) approach was adopted to define the strength of recommendations and the quality of evidence.The article has been co-published with permission in the European Journal of Cardio-Thoracic Surgery and the European Respiratory Journal. Recommendations 1 For mediastinal nodal staging in patients with suspected or proven non-small-cell lung cancer (NSCLC) with abnormal mediastinal and/or hilar nodes at computed tomography (CT) and/or positron emission tomography (PET), endosonography is recommended over surgical staging as the initial procedure (Recommendation grade A). The combination of endobronchial ultrasound with real-time guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic (esophageal) ultrasound with fine needle aspiration, with use of a gastrointestinal (EUS-FNA) or EBUS (EUS-B-FNA) scope, is preferred over either test alone (Recommendation grade C). If the combination of EBUS and EUS-(B) is not available, we suggest that EBUS alone is acceptable (Recommendation grade C).Subsequent surgical staging is recommended, when endosonography does not show malignant nodal involvement (Recommendation grade B). 2 For mediastinal nodal staging in patients with suspected or proven non-small-cell peripheral lung cancer without mediastinal involvement at CT or CT-PET, we suggest that EBUS-TBNA and/or EUS-(B)-FNA should be performed before therapy, provided that one or more of the following conditions is present: (i) enlarged or fluorodeoxyglucose (FDG)-PET-avid ipsilateral hilar nodes; (ii) primary tumor without FDG uptake; (iii) tumor size ??3?cm (Fig.?3a?-?c) (Recommendation grade C). If endosonography does not show malignant nodal involvement, we suggest that mediastinoscopy is considered, especially in suspected N1 disease (Recommendation grade C).If PET is not available and CT does not reveal enlarged hilar or mediastinal lymph nodes, we suggest performance of EBUS-TBNA and/or EUS-(B)-FNA and/or surgical staging (Recommendation grade C). 3 In patients with suspected or proven?staging (Recommendation grade C). 4 For mediastinal staging in patients with centrally located suspected or proven NSCLC without mediastinal or hilar involvement at CT and/or CT-PET, we suggest performance of EBUS-TBNA, with or without EUS-(B)-FNA, in preference to surgical staging (Fig.?4) (Recommendation grade D). If endosonography does not show malignant nodal involvement, mediastinoscopy may be considered (Recommendation grade D). 5 For mediastinal nodal restaging following neoadjuvant therapy, EBUS-TBNA and/or EUS-(B)-FNA is suggested for detection of persistent nodal disease, but, if this is negative, subsequent surgical staging is indicated (Recommendation grade C). 6 A complete assessment of mediastinal and hilar nodal stations, and sampling of at least three different mediastinal nodal stations (4?R, 4?L, 7) (Fig.?1, Fig.?5) is suggested in patients with NSCLC and an abnormal mediastinum by CT or CT-PET (Recommendation grade D). 7 For diagnostic purposes, in patients with a centrally located lung tumor that is not visible at conventional bronchoscopy, endosonography is suggested, provided the tumor is located immediately adjacent to the larger airways (EBUS) or esophagus (EUS-(B)) (Recommendation grade D). 8 In patients with a left adrenal gland suspected for distant metastasis we suggest performance of endoscopic ultrasound fine needle aspiration (EUS-FNA) (Recommendation grade C), while the use of EUS-B with a transgastric approach is at present experimental (Recommenda

  2. Diet and esophageal disease.

    PubMed

    Dawsey, Sanford M; Fagundes, Renato B; Jacobson, Brian C; Kresty, Laura A; Mallery, Susan R; Paski, Shirley; van den Brandt, Piet A

    2014-09-01

    The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on macronutrients, dietary patterns, and risk of adenocarcinoma in Barrett's esophagus; micronutrients, trace elements, and risk of Barrett's esophagus and esophageal adenocarcinoma; the role of mate consumption in the development of squamous cell carcinoma; the relationship between energy excess and development of esophageal adenocarcinoma; and the nutritional management of the esophageal cancer patient. PMID:25266021

  3. Esophageal duplication cyst.

    PubMed

    Bagheri, Reza; Asnaashari, Amir Mohammad Hashem; Afghani, Reza

    2015-03-01

    Esophageal duplication cyst is a rare congenital mediastinal cyst. Most of these cysts become symptomatic in childhood and only rare cases remain asymptomatic until adolescence. They may produce symptoms due to esophageal and respiratory system compression, rupture, and infection. A 25-year-old man presented with pulmonary infection and bronchiectasis that did not improve with medical treatment. A diagnosis of esophageal duplication cyst was made intraoperatively. PMID:24757179

  4. Esophageal lichen planus.

    PubMed

    Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

    2015-01-01

    Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis. PMID:26131872

  5. Esophageal cancer: results of an American College of Surgeons patient care evaluation study 1 1 No competing interests declared

    Microsoft Academic Search

    John M Daly; Willard A Fry; Alex G Little; David P Winchester; Rosemary F McKee; Andrew K Stewart; Amy M Fremgen

    2000-01-01

    Background: The last two decades have seen changes in the prevalence, histologic type, and management algorithms for patients with esophageal cancer. The purpose of this study was to evaluate the presentation, stage distribution, and treatment of patients with esophageal cancer using the National Cancer Database of the American College of Surgeons.Study Design: Consecutively accessed patients (n = 5,044) with esophageal

  6. CHEMICAL INTERACTIONS OF ARSENATE, ARSENITE, PHOSPHATE, AND SILICATE WITH IRON (II,III) HYDROXYCARBONATE GREEN RUST

    EPA Science Inventory

    Granular zerovalent iron has been proposed to be used as a medium in permeable reactive barriers (PRBs) to remove arsenic from contaminated groundwater. Iron(II, III) hydroxycarbonate green rust (carbonate green rust, or CGR) is a major corrosion product of zerovalent iron under ...

  7. CHEMICAL INTERACTIONS OF ARSENATE, ARSENITE, PHOSPHATE, AND SILICATE WITH IRON (II, III) HYDROXYCARBONATE GREEN RUST

    EPA Science Inventory

    Granular zerovalent iron has been proposed to be used as a medium in permeable reactive barriers (PRBs) to remove arsenic from contaminated groundwater. Iron(II, III) hydroxycarbonate green rust (carbonate green rust, or CGR) is a major corrosion product of zerovalent iron under ...

  8. Drug-induced esophagitis.

    PubMed

    Zografos, G N; Georgiadou, D; Thomas, D; Kaltsas, G; Digalakis, M

    2009-01-01

    Drug-induced esophagitis is being recognized increasingly in the past few years. Since 1970 more than 650 cases have been reported worldwide caused by 30 or more medications. We have reviewed these cases with a view to classifying this disease based on underlying pathological mechanism. Drug-induced esophageal injury tends to occur at the anatomical site of narrowing, with the middle third behind the left atrium predominating (75.6%). The disease is broadly classified into two groups. The first group being transient and self-limiting as exemplified by the tetracycline group induced injury (65.8%). The second is the persistent esophagitis group, often with stricture, with two distinct entities: (i) patients on nonsteroidal anti-inflammatory agents whose injury is aggravated by gastroesophageal reflux (21.8%) (reflux aggravated); and (ii) patients with potasium chloride and quinidine sulphate induced injury (12.4%) (persistent drug injury). Severe esophageal injury has been reported in some women taking biphosphonates as treatment for postmenopausal osteoporosis. Endoscopic findings in such patients with esophageal injury generally suggested a chemical esophagitis, with erosions or ulcerations and exudative inflammation accompanied by thickening of the esophageal wall. Most cases of medication-induced esophageal injury heal without intervention within a few days. Thus, the most important aspect of therapy is to make the correct diagnosis and then to avoid reinjury with the drug. When possible, potentially caustic oral medications should be discontinued. PMID:19392845

  9. Esophageal cancer in Iran

    Microsoft Academic Search

    A Ghavamzadeh; A Moussavi; M Jahani; M Rastegarpanah; M Iravani

    2001-01-01

    Esophageal cancer is among the 10 most frequent cancers in the world. Iran is one of the known areas with a high incidence of esophageal cancer. Most of the patients in Iran have been reported from the north and northeast regions of the country. In one survey by the Iran Cancer Institute, 9% of all cancers and 27% of gastrointestinal

  10. Esophageal pH monitoring

    MedlinePLUS

    pH monitoring - esophageal; Esophageal acidity test ... to stay in the hospital for the esophageal pH monitoring. ... Esophageal pH monitoring is used to check how much stomach acid is entering the esophagus. It also checks how ...

  11. Esophageal endosclerosis in children.

    PubMed

    Stellen, G P; Lilly, J R

    1985-11-01

    During the past 6 years, 25 consecutive patients with esophageal variceal hemorrhage were treated by esophageal endosclerosis (direct injection of varices with a sclerosing agent). The primary disease in the 25 children was portal vein thrombosis (11 patients), biliary atresia (nine patients), and hepatic cirrhosis from cystic fibrosis (three patients), alpha 1-antitrypsin deficiency (one patient), and neonatal hepatitis (one patient). Thirteen patients were treated during acute, major variceal hemorrhage. Esophageal endosclerosis was repeated at regular intervals until all esophageal varices were obliterated. Twenty-one patients completed therapy. Four patients died: one of a complication of therapy and three of the primary disease. Other than the one death, complications were minor. Recurrent esophageal variceal hemorrhage has not been encountered in follow-up from 9 months to 6 years after completion of therapy. PMID:3877348

  12. NF-?B Activation in Esophageal Adenocarcinoma

    PubMed Central

    Abdel-Latif, Mohamed M. M.; O'Riordan, James; Windle, Henry J.; Carton, Eleanor; Ravi, Nagunivan; Kelleher, Dermot; Reynolds, John V.

    2004-01-01

    Objective: To examine the expression of the transcription factor nuclear factor kappa B (NF-?B) in Barrett's epithelium and adenocarcinoma and the impact of NF-?B expression on tumor stage and response to neoadjuvant chemotherapy and radiation therapy. Summary Background Data: Progression of Barrett's esophagus to adenocarcinoma is associated with a wide range of cellular and molecular abnormalities. Nuclear factor-kappa B (NF-?B) regulates several genes involved in inflammatory, immune and apoptotic responses, but its role in esophageal inflammation and tumorigenesis has not been reported. Methods: Mobility shift assay was used to measure NF-?B activity in nuclear extracts of fresh-frozen biopsies from tumor and uninvolved tissues (n = 30) and esophageal cell lines OE33, SKGT-4, and OE21. RelA expression was assessed by immunohistochemical staining (n = 97). The NF-?B/RelA and I?B protein expressions were also examined by Western blotting. Results: NF-?B was not expressed in normal esophageal squamous epithelium, in contrast to increased expression in 40% of patients with Barrett's epithelium. Sixty-one percent of resected tumors (n = 97) displayed NF-?B immunoreactivity, and 87.5% of the NF-?B- positive tumors were Stage IIb and III compared with only 12.5% of patients with Stage I and IIa disease (P < 0.05). The expression of NF-?B inversely correlated with major or complete pathologic responses to neoadjuvant chemotherapy and radiation therapy, with 15/20 (75%) responders in the NF-?B-negative group compared with 7/38 (18%) in the NF-?B-positive group (P < 0.00001). Moreover, incubation of esophageal cell lines OE33, SKGT-4, and OE21 with deoxycholic acid or low pH induced NF-?B expression. Conclusions: Bile acids and low pH induce NF-?B expression in esophageal cell lines. NF-?B activation is common in esophageal adenocarcinoma. In patients with Barrett's epithelium and an associated esophageal adenocarcinoma, there is a progressive expression of NF-?B through Barrett's tumorigenesis. The absence of NF-?B expression in esophageal adenocarcinoma correlates with response to neoadjuvant chemoradiotherapy and may be of value in predicting response to neoadjuvant therapy. PMID:15024310

  13. Endoscopic assessment and management of early esophageal adenocarcinoma

    PubMed Central

    Hammoud, Ghassan M; Hammad, Hazem; Ibdah, Jamal A

    2014-01-01

    Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion. PMID:25132925

  14. Regulatory Fe(II/III) heme: the reconstruction of a molecule's biography.

    PubMed

    Kühl, Toni; Imhof, Diana

    2014-09-22

    More than 20 years of research on heme as a temporary effector molecule of proteins have revealed its widespread impact on virtually all primary functions in the human organism. As our understanding of this influence is still growing, a comprehensive overview of compiled data will give fresh impetus for creativity and developing new strategies in heme-related research. From known data concerning heme-regulated proteins and their involvement in the development of diseases, we provide concise information of Fe(II/III) heme as a regulator and the availability of "regulatory heme". The latter is dependent on the balance between free and bound Fe(II/III) heme, here termed "hemeostasis". Imbalance of this system can lead to the development of diseases that were not always attributed to this small molecule. Diseases such as cancer or Alzheimer's disease highlight the reawakened interest in heme, whose function was previously believed to be completely understood. PMID:25196849

  15. Night eating syndrome in class II–III obesity: metabolic and psychopathological features

    Microsoft Academic Search

    S Calugi; R Dalle Grave; G Marchesini

    2009-01-01

    Objective:To investigate the relationship of metabolic disorders and psychological features with the night eating syndrome (NES) in individuals with moderate-to-severe obesity.Design:Cross-sectional observation.Subjects:A total of 266 consecutive participants with class II–III obesity, entering an inpatient weight loss program.Measurements:Participants who reported consuming either a large amount of their caloric intake after the evening meal (roughly self-assessed as ?25% of daily calories) or

  16. Electronic and Geometric Structure of a Trinuclear Mixed-Valence Copper(II,II,III) Cluster

    Microsoft Academic Search

    David E. Root; Mark J. Henson; Tim Machonkin; Pulakesh Mukherjee; T. D. P. Stack; Edward I. Solomon

    1998-01-01

    The four-electron reduction of dioxygen to water by trinuclear copper clusters is of great biological significance. Recently we reported the crystal structure of a trinuclear model complex in which the three coppers provide the four electrons necessary to fully reduce dioxygen, generating two Ì3-oxo bridges. This complex is best described as a localized, mixed-valence Cu(II,II,III) system which has C2V effective

  17. Spatial orientations of galaxies in 10 Abell clusters of BM type II-III

    NASA Astrophysics Data System (ADS)

    Aryal, B.; Saurer, W.

    2006-02-01

    We present an analysis of the spatial orientations of 1315 galaxies in 10 Abell clusters of BM type II-III (type II-III in the Bautz-Morgan system). It is found that the spin-vector orientations of the galaxies in six clusters (Abell 168, 426, 1035, 1227, 1367 and 1904) tend to lie parallel to the Local Supercluster (LSC) plane. The spin-vector projections of galaxies in six clusters (Abell 168, 1020, 1035, 1227, 1904 and 1920) are found to be oriented perpendicular with respect to the direction of the LSC centre. Three clusters (Abell 1920, 2255 and 2256) show a bimodal orientation: spin vectors tend to be oriented both parallel and perpendicular to the LSC plane. No dependence of radial velocity, distance and cluster magnitude on galaxy orientation is noticed. In a comparison with previous work, we noticed that the anisotropy might increase from early-type (BM type I) to late-type (BM types II-III and III) clusters. We notice a vanishing angular momentum for the less massive galaxy clusters (richness class 0). A significant alignment of the angular momenta of galaxies for massive clusters, e.g. the core of the Shapley Supercluster (richness class 4, M > 1015Msolar), is found.

  18. Effect of Slip Time in Forming Neo-Esophageal Stenosis After Replacement of a Thoracic Esophagus With Nitinol Artificial Esophagus.

    PubMed

    Liang, Xian-Liang; Liang, Jian-Hui

    2015-07-01

    Attempts have been made to investigate the effect of slip time of nitinol artificial esophagus for forming neo-esophageal stenosis after replacement of a thoracic esophagus with nitinol artificial esophagus in 20 experimental pigs. The pigs whose slip time was less than 90 days postoperatively had severe dysphagia (Bown's III) immediately after they were fed, and the dysphagia aggravated gradually later on (Bown's III-IV). The pigs whose slip time was more than 90 days postoperatively had mild/moderate dysphagia (Bown's I-II) immediately after they were fed, and the dysphagia relieved gradually later on (Bown's II-I-0). The ratios between the diameter of neo-esophagus in different slip time and normal esophagus were 25% (at 2 months postoperatively), 58% (at 4 months postoperatively), and 93% (at 6 months postoperatively), respectively. The relationship between nitinol artificial esophagus slip time and neo-esophageal stenosis showed a positive correlation. After replacement of a thoracic esophagus with nitinol artificial esophagus, the artificial esophageal slip time not only affected the original diameter of the neo-esophagus immediately, but also affected the neo-esophageal scar stricture forming process later on. The narrowing of neo-esophagus is caused by overgrowth of scar tissue. But there is the positive correlation between artificial esophagus slip time and neo-esophageal stenosis, so this can be a way of overcoming neo-esophageal stenosis by delaying slip time of artificial esophagus. PMID:25809956

  19. Stage at Diagnosis | Cancer Trends Progress Report

    Cancer.gov

    Cancers can be diagnosed at different stages in their development. Stage of cancer diagnosis may be expressed as numbers (for example, I, II, III, or IV) or by terms such as “localized,” “regional,” and “distant.” The lower the number or the more localized the cancer, the better a person’s chances of benefiting from treatment.

  20. Esophageal Rupture in a Patient With Idiopathic Eosinophilic Esophagitis

    Microsoft Academic Search

    Peter J Riou; Andrew G Nicholson; Ugo Pastorino

    1996-01-01

    Idiopathic eosinophilic esophagitis is an extremely rare condition with fewer than 20 cases described in the literature. We present a case presenting as an emergency with esophageal perforation that eventually required subtotal esophagectomy.

  1. Eosinophilic Esophagitis: Strictures, Impactions, Dysphagia

    Microsoft Academic Search

    Seema Khan; Susan R. Orenstein; Carlo Di Lorenzo; Samuel A. Kocoshis; Philip E. Putnam; Luther Sigurdsson; Theresa M. Shalaby

    2003-01-01

    Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive

  2. A randomized controlled Phase II/III study comparing endoscopic balloon dilation combined with steroid injection versus radial incision and cutting combined with steroid injection for refractory anastomotic stricture after esophagectomy: Japan Clinical Oncology Group Study JCOG1207.

    PubMed

    Kataoka, Kozo; Aoyama, Ikuo; Mizusawa, Junki; Eba, Junko; Minashi, Keiko; Yano, Tomonori; Tanaka, Masaki; Hanaoka, Noboru; Katayama, Hiroshi; Takizawa, Kohei; Fukuda, Haruhiko; Muto, Manabu

    2015-04-01

    A randomized Phase II/III trial commenced in May 2014. Endoscopic balloon dilation with steroid injection is the current standard treatment for patients with refractory anastomotic stricture after esophagectomy. The purpose of this study is to confirm the superiority of radial incision and cutting with steroid injection in terms of both restricture-free survival and number of dilations within 24 weeks compared with endoscopic balloon dilation with steroid injection for these patients. A total of 130 patients will be accrued from 30 Japanese institutions over 3 years. The primary endpoint in the Phase II part is proportion of Grade 3/4 intraoperative hemorrhages, post-operative esophageal perforations, esophageal hemorrhages, pneumothorax, lung or mediastinum infections or other unexpected adverse events. Co-primary endpoints in the Phase III part are restricture-free survival and number of dilations within 24 weeks after treatment. Secondary endpoints are proportion of patients with anastomotic diameter >10 mm at 8 weeks after treatment, proportion of adverse events, proportion of patients experiencing improvement of dysphagia score at 2, 4, 8 and 24 weeks after treatment and proportion of patients with dysphagia score ?1 at 24 weeks after treatment. This trial has been registered in the UMIN Clinical Trials Registry as UMIN000014017 [http://www.umin.ac.jp/ctr/index.htm]. PMID:25628348

  3. Aluminium substitution in iron(II–III)-layered double hydroxides: Formation and cationic order

    Microsoft Academic Search

    Christian Ruby; Mustapha Abdelmoula; Rabha Aissa; Ghouti Medjahdi; Michela Brunelli; Michel François

    2008-01-01

    The formation and the modifications of the structural properties of an aluminium-substituted iron(II–III)-layered double hydroxide (LDH) of formula Fe4IIFe(2-6y)IIIAl6yIII (OH)12 SO4, 8H2O are followed by pH titration curves, Mössbauer spectroscopy and high-resolution X-ray powder diffraction using synchrotron radiation. Rietveld refinements allow to build a structural model for hydroxysulphate green rust, GR(SO42?), i.e. y=0, in which a bilayer of sulphate anions

  4. Novel triphenylamine donors with carbazole moieties for organic sensitizers toward cobalt(II/III) redox mediators.

    PubMed

    Tan, Yulin; Liang, Mao; Lu, Ziyi; Zheng, Yequan; Tong, Xinli; Sun, Zhe; Xue, Song

    2014-08-01

    A series of D-?-A organic dyes, X72-75, containing novel triarylamine electron donors have been synthesized for dye-sensitized solar cells (DSCs). The superiority of the asymmetric design of the triphenylamine electron donor over the symmetrical triphenylamine when applied in organic dyes for cobalt cells has been observed. Using X72 with the cobalt(II/III) redox shuttle resulted in an overall power conversion efficiency (PCE) of 9.18%, outperforming the state-of-the-art dye C218 under the same conditions. PMID:25058325

  5. Two cases of esophageal eosinophilia: eosinophilic esophagitis or gastro-esophageal reflux disease?

    PubMed

    Yilmaz, Ozlem; Karagol, Hacer Ilbilge Ertoy; Topal, Erdem; Unlusoy, Aysel Aksu; Egritas, Odul; Gonul, Ipek Isik; Bakirtas, Arzu

    2014-05-01

    Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease are among the major causes of isolated esophageal eosinophilia. Isolated esophageal eosinophilia meeting criteria for EoE may respond to proton pump inhibitor (PPI) treatment. This entity is termed proton pumps inhibitor responsive esophageal eosinophilia (PPI-REE). Gastro-esophageal reflux is thought to comprise a subgroup of patients with PPI-REE. According to the latest guidelines, PPI responsiveness distinguishes people with PPI-REE from patients having EoE (non-responders). In this report, two unusual cases with findings belonging to both EoE and PPI-REE are discussed with known and unknown facts. PMID:24987510

  6. Cyclization of the intrinsically disordered ?1S dihydropyridine receptor II-III loop enhances secondary structure and in vitro function.

    PubMed

    Tae, Han-Shen; Cui, Yanfang; Karunasekara, Yamuna; Board, Philip G; Dulhunty, Angela F; Casarotto, Marco G

    2011-06-24

    A key component of excitation contraction (EC) coupling in skeletal muscle is the cytoplasmic linker (II-III loop) between the second and third transmembrane repeats of the ?(1S) subunit of the dihydropyridine receptor (DHPR). The II-III loop has been previously examined in vitro using a linear II-III loop with unrestrained N- and C-terminal ends. To better reproduce the loop structure in its native environment (tethered to the DHPR transmembrane domains), we have joined the N and C termini using intein-mediated technology. Circular dichroism and NMR spectroscopy revealed a structural shift in the cyclized loop toward a protein with increased ?-helical and ?-strand structure in a region of the loop implicated in its in vitro function and also in a critical region for EC coupling. The affinity of binding of the II-III loop binding to the SPRY2 domain of the skeletal ryanodine receptor (RyR1) increased 4-fold, and its ability to activate RyR1 channels in lipid bilayers was enhanced 3-fold by cyclization. These functional changes were predicted consequences of the structural enhancement. We suggest that tethering the N and C termini stabilized secondary structural elements in the DHPR II-III loop and may reflect structural and dynamic characteristics of the loop that are inherent in EC coupling. PMID:21525002

  7. Effects of ketamine on synaptic transmission and long-term potentiation in layer II\\/III of rat visual cortex in vitro

    Microsoft Academic Search

    Mahmoud Salami; Yaghoub Fathollahi; Hossein Esteky; Fereshteh Motamedi; Nafiseh Atapour

    2000-01-01

    The effects of ketamine, which has NMDA receptor antagonist properties, on synaptic transmission and long-term potentiation in layer II\\/III of adult rat visual cortex were examined in vitro. Field potentials were recorded in layer II\\/III following layer IV stimulation. Primed-burst stimulation was used for induction of long-term potentiation. Stimulation of layer IV resulted in a two-component response in layer II\\/III,

  8. Can esophageal dilation be avoided in the treatment of severe esophageal stricture caused by eosinophilic esophagitis?

    PubMed

    Silva, D; Santos, F; Piedade, S; Morais-Almeida, M

    2015-07-01

    Eosinophilic esophagitis (EoE) is an inflammatory immune-mediated disease with predominant eosinophilic inflammation characterized by the presence of esophageal dysfunction symptoms. Treatment delay can be associated with disease complications, like esophageal strictures, that can justify the use of invasive procedures which are not deprived of side effects. We present a case report of a 14 year old child with severe esophageal stricture secondary to EoE, that was treated with topical and systemic corticosteroid before any invasive procedure was considered. After 26 weeks of medical treatment, significant improvement of esophageal dysfunction occurred with histological remission and stricture resolution. In patients with severe esophageal strictures secondary to EoE, the need for esophageal dilation procedures should be considered only after anti-inflammatory treatment. PMID:26159479

  9. Nutrition and esophageal cancer

    Microsoft Academic Search

    K. K. Cheng; N. E. Day

    1996-01-01

    Epidemiologic evidence on the relation between nutrition and esophageal cancer is reviewed. Results from ecologic, case-control, cohort, and intervention studies are included. Most of the findings pertain more to squamous cell carcinoma than adenocarcinoma of the esophagus. The protective effect of fruit and vegetable consumption is supported by a large body of evidence, especially from case-control studies. The effects of

  10. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  11. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  12. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  13. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  14. 21 CFR 876.5365 - Esophageal dilator.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5365 Esophageal dilator. (a) Identification. An esophageal...

  15. An Overview of Eosinophilic Esophagitis

    PubMed Central

    Park, Hyojin

    2014-01-01

    Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease affecting both children and adults. The condition is characterized by an eosinophilic infiltration of the esophageal epithelium. Symptoms of esophageal dysfunction include dysphagia, food impaction and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination typically reveals mucosal fragility, ring or corrugated mucosa, longitudinal furrows, whitish plaques or a small caliber esophagus. Histologic findings of >15 eosinophils per high-power field is the diagnostic hallmark of EoE. An elimination diet, topical corticosteroids or endoscopic dilation for fibrostenotic disease serve as effective therapeutic option. PMID:25368745

  16. Biopsy-negative malignant esophageal stricture: diagnosis by endoscopic ultrasound

    Microsoft Academic Search

    Douglas O. Faigel; Clifford Deveney; Daniel Phillips; M. Brian Fennerty

    1998-01-01

    Endoscopic ultrasound (EUS) of the esophagus has been used primarily in staging biopsy-proven cancers. Its use as a primary diagnostic modality for esophageal malignancy has not been previously described. We report our recent experience in four patients with dysphagia and endoscopic biopsies negative for malignancy, including one patient with clinical and manometric features suggestive of achalasia. In all cases, EUS

  17. [Eosinophilic esophagitis diagnostic features].

    PubMed

    2015-01-01

    Eosinophilic esophagitis (EoE) is a chronic inflammatory disease characterized by eosinophilic infiltration and inflammation of the gastrointestinal tract in the absence of other causes of tissue eosinophilia. The clinical course of EoE like gastroesophageal reflux disease with eosinophilic infiltration of the esophageal epithelium. EoE widely diagnosed abroad in children and adults, whereas in Russia the disease is almost never diagnosed. Upon detection of eosinophilia in the biopsy of the esophagus should exclude other causes. The correct clinical diagnosis in combination with the study of biopsy tissue of the esophagus and other laboratory methods (including allergic testing) is crucial in achieving the effectiveness of therapy EoE. PMID:25993874

  18. CISNET: Esophageal Cancer

    Cancer.gov

    The incidence of esophageal adenocarcinoma (EAC) has been rising at an alarming rate over the past four decades. Although the absolute number of EAC cases per year remains too low to screen the general population, targeted screening may be appropriate. Heartburn, the primary symptom of gastroesophageal reflux disease (GERD), affects 40-60 million Americans and can lead to Barrett's esophagus (BE), a premalignant condition associated with the greatest risk of developing EAC.

  19. FATE OF NICKEL ION IN (II-III) HYDROXYSULPHATE GREEN RUST SYNTHESIZED BY... 813 R. Bras. Ci. Solo, 31:813-818, 2007

    E-print Network

    Chorover, Jon

    FATE OF NICKEL ION IN (II-III) HYDROXYSULPHATE GREEN RUST SYNTHESIZED BY... 813 R. Bras. Ci. Solo, 31:813-818, 2007 FATE OF NICKEL ION IN (II-III) HYDROXYSULPHATE GREEN RUST SYNTHESIZED the environment by coprecipitation. Index terms: nickel incorporation, nickel adsorption, X-ray diffraction

  20. Hypnotherapy for Esophageal Disorders.

    PubMed

    Riehl, Megan E; Keefer, Laurie

    2015-01-01

    Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms-visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome. PMID:26046715

  1. Eosinophilic esophagitis in children.

    PubMed

    Trivedy, Prerna; Teitelbaum, Jonathan E

    2015-06-01

    Eosinophilic esophagitis (EoE) is a relatively common chronic immune-mediated disease of the esophagus characterized clinically by symptoms of esophageal dysfunction that vary by age. Histologically, EoE results in marked esophageal eosinophilia despite treatment with high-dose proton pump inhibition. The cornerstone of treatment is dietary restriction and/or pharmacologic therapy, mainly with topical steroids. This review briefly describes dietary therapy, but focuses on the various medical options in the treatment of EoE, with an emphasis on steroid-based therapy. Numerous landmark studies are reviewed describing the symptomatic and histologic endpoints as well as safety data. The literature strongly supports the use of topical steroid therapy as a means of significantly decreasing eosinophilic mucosal disease. Specifically, high-dose fluticasone propionate appears to be very effective, and has been shown to result in the resolution of mucosal eosinophilia in a large percentage of treated patients. Long-term studies over many years will need to determine whether mucosal healing will change the natural history of this stricture-causing disease. In addition to topical therapy, various other drug-based therapies are reported, including newer immune-based monoclonal antibodies. PMID:25792526

  2. Helical CT versus EUS with fine needle aspiration for celiac nodal assessment in patients with esophageal cancer

    Microsoft Academic Search

    Joseph Romagnuolo; John Scott; Robert H. Hawes; Brenda J. Hoffman; Carolyn E. Reed; Guruprasad P. Aithal; Niall P. Breslin; Robert Y. M. Chen; Bora Gumustop; Winnie Hennessey; Annette Van Velse; Michael B. Wallace

    2002-01-01

    Background: Conventional CT is insensitive for detection of metastatic involvement of celiac lymph nodes in esophageal cancer. Helical CT has theoretical advantages over “slice” CT in this regard, but its performance has not yet been prospectively studied. Methods: Consecutive patients with untreated esophageal cancer were recruited after obtaining informed consent. Helical CT was performed on all patients and TNM staging

  3. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...false Esophageal stethoscope with electrical conductors. 868.1920 Section...1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device...

  4. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...false Esophageal stethoscope with electrical conductors. 868.1920 Section...1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device...

  5. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Esophageal stethoscope with electrical conductors. 868.1920 Section 868...Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device that is...

  6. 21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Esophageal stethoscope with electrical conductors. 868.1920 Section 868...Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device that is...

  7. Esophageal metastasis from breast carcinoma.

    PubMed

    Vergote, G; Ponette, E; Verschakelen, J; Baert, A L; Rutgeerts, P; Moerman, P

    1994-12-01

    A case of esophageal metastasis from a breast carcinoma is presented. Location was, as usual, midesophageal. The interval of time between breast carcinoma and the onset of esophageal symptoms was rather long. Barium swallow examination enabled correct diagnosis, whereas several series of superficial endoscopical biopsies were negative. Diagnosis was confirmed by deep endoscopical biopsy. PMID:7829460

  8. Pill-induced esophageal injury

    Microsoft Academic Search

    James Walter Kikendall; Arnold C. Friedman; Morakinyo Anthony Oyewole; David Fleischer; Lawrence F. Johnson

    1983-01-01

    We report four cases of esophageal injury associated with the ingestion of commonly prescribed tablets or capsules. History and clinical characteristics of these cases suggest that the medications failed to transit the esophagus and acted locally to produce esophagitis. A search of English- and foreign-language medical journals documented 221 similar cases due to 26 different types of medication. While most

  9. Lichen Planus With Esophageal Involvement

    Microsoft Academic Search

    F. Valdés; A. Caparrini; J. M. Calzada

    2007-01-01

    Lichen planus is an inflammatory disease of unknown etiology which may affect the esophagus. Patients with esophageal lichen planus are usually elderly women. The most frequent symptoms are dysphagia and odynophagia. There is usually concomitant oral involvement in cases of esophageal lichen planus. Endoscopic findings include erosions, exudates and stenosis. Systemic steroids are the most effective therapy for these patients.

  10. An Update on Modern Approaches to Localized Esophageal Cancer

    PubMed Central

    Welsh, James; Amini, Arya; Likhacheva, Anna; Erasmus, Jeremy; Gomez, Daniel; Davila, Marta; Mehran, Reza J; Komaki, Ritsuko; Liao, Zhongxing; Hofstetter, Wayne L; Bhutani, Manoop; Ajani, Jaffer A

    2014-01-01

    Esophageal cancer treatment continues to be a topic of wide debate. Based on improvements in chemotherapy drugs, surgical techniques, and radiotherapy advances, esophageal cancer treatment approaches are becoming more specific to the stage of the tumor and the overall performance status of the patient. While surgery continues to be the standard treatment option for localized disease, the current direction favors multimodality treatment including both radiation and chemotherapy with surgery. In the next few years, we will continue to see improvements in radiation techniques and proton treatment, with more minimally invasive surgical approaches minimizing postoperative side effects, and the discovery of molecular biomarkers to help deliver more specifically targeted medication to treat esophageal cancers. PMID:21365188

  11. [Esophageal toxicity of radiation therapy: clinical risk factors and management].

    PubMed

    Challand, T; Thureau, S; Dubray, B; Giraud, P

    2012-09-01

    Acute radiation-induced esophagitis includes all clinical symptoms (odynophagia, dysphagia) occurring within 90 days after thoracic irradiation start. Its severity can be graded using RTOG and CTCAE scales. The clinical risk factors are: age, female gender, initial performance status, pre-therapeutic body mass index, pre-therapeutic dysphagia, tumoral and nodal stage, delivered dose, accelerated hyperfractionned radiotherapy, concomitant association of chemotherapy to radiotherapy and response to the treatment. The dosimetric parameters predictive of esophagitis are: mean dose, V(20Gy), V(30Gy), V(40Gy), V(45Gy) and V(50Gy). Amifostine is the only drug to have a proven radioprotective efficacy (evidence level C, ESMO recommendation grade III). The medical management of esophagitis associates a diet excluding irritant food, medication against gastroesophageal reflux, analgesic treatment according to the WHO scale and management of dehydration and denutrition by enteral feeding. PMID:22925486

  12. Conventional X-ray examination in esophageal cancer: an opinion.

    PubMed

    Ponette, E; Dekeyzer, M; Van Steen, A; Lerut, T; Broeckaert, L; Geboes, K

    1991-01-01

    Double contrast is the best radiological technique for the detection of small esophageal cancer. Gastrografin is indicated when a blind mediastinal fistula is suspected; in cases of choking or suspicion of a fistula with the airways, a low osmotic hydrosoluble Iodium compound must be used. Conventional radiology and endoscopy are complementary techniques for the detection of esophageal cancer, as some lesions may be missed or misinterpreted by both. The need for endoscopic biopsy being incontestable for diagnostic confirmation and characterization, radiology presents some advantages over classic esophagoscopy for preoperative and the general pretherapeutic staging of esophageal carcinoma: assessment of topographical relation with the surrounding organs is possible and with the upper esophageal sphincter is easier; appreciation of tumoral extension along the longitudinal axis (tumor length, gastric invasion) remains mostly possible even in cases of severe stenosis; tumoral extension along the transverse axis (kinking, fistula) may be evaluated; detection of a second tumor or concomitant pathology distally from a stenosing tumor is mostly possible; moreover radiology is important before starting radiotherapy; and finally, previous radiology may reduce the (small) risk of endoscopic perforation. Radiology is indispensable or indicated in the posttherapeutic follow-up of esophageal carcinoma, as well after surgery as after endoscopic interventions, radiotherapy or chemotherapy. PMID:1797799

  13. Aluminium substitution in iron(II-III)-layered double hydroxides: Formation and cationic order

    SciTech Connect

    Ruby, Christian [Laboratoire de Chimie Physique et Microbiologie pour l'Environnement, LCPME UMR7564 CNRS-Nancy Universite, 405 rue de Vandoeuvre, 54600 Villers-les-Nancy (France)], E-mail: Christian.ruby@lcpme.cnrs-nancy.fr; Abdelmoula, Mustapha; Aissa, Rabha [Laboratoire de Chimie Physique et Microbiologie pour l'Environnement, LCPME UMR7564 CNRS-Nancy Universite, 405 rue de Vandoeuvre, 54600 Villers-les-Nancy (France); Medjahdi, Ghouti [Laboratoire de Chimie du Solide Mineral, LCSM UMR 7555 CNRS-Nancy Universite, Faculte des Sciences, BP239, 54506 Vandoeuvre-les-Nancy (France); Brunelli, Michela [European Synchrotron Radiation Facility (ESRF), 6 rue Jules Horowitz, BP 220, 38043 Grenoble Cedex (France); Francois, Michel [Laboratoire de Chimie du Solide Mineral, LCSM UMR 7555 CNRS-Nancy Universite, Faculte des Sciences, BP239, 54506 Vandoeuvre-les-Nancy (France)

    2008-09-15

    The formation and the modifications of the structural properties of an aluminium-substituted iron(II-III)-layered double hydroxide (LDH) of formula Fe{sub 4}{sup II}Fe{sub (2-6y)}{sup III}Al{sub 6y}{sup III} (OH){sub 12} SO{sub 4}, 8H{sub 2}O are followed by pH titration curves, Moessbauer spectroscopy and high-resolution X-ray powder diffraction using synchrotron radiation. Rietveld refinements allow to build a structural model for hydroxysulphate green rust, GR(SO{sub 4}{sup 2-}), i.e. y=0, in which a bilayer of sulphate anions points to the Fe{sup 3+} species. A cationic order is proposed to occur in both GR(SO{sub 4}{sup 2-}) and aluminium-substituted hydroxysulphate green rust when y<0.08. Variation of the cell parameters and a sharp decrease in average crystal size and anisotropy are detected for an aluminium content as low as y=0.01. The formation of Al-GR(SO{sub 4}{sup 2-}) is preceded by the successive precipitation of Fe{sup III} and Al{sup III} (oxy)hydroxides. Adsorption of more soluble Al{sup III} species onto the initially formed ferric oxyhydroxide may be responsible for this slowdown of crystal growth. Therefore, the insertion of low aluminium amount (y{approx}0.01) could be an interesting way for increasing the surface reactivity of iron(II-III) LDH that maintains constant the quantity of the reactive Fe{sup II} species of the material. - Graphical abstract: (a) Crystallographical structure of sulphated green rust: SO{sub 4}{sup 2-} point to the Fe{sup 3+} cations (red) that form an ordered array with the Fe{sup 2+} cations (green). (b) Width and asymmetry of the synchrotron XRD peaks increase rapidly when some Al{sup 3+} species substitute the Fe{sup 3+} cations; z is molar ratio Al{sup 3+}/Fe{sup 3+}.

  14. [Invaginated esophageal anastomosis].

    PubMed

    Petrov, V P; Mikhalkin, M P; Rozhkov, A G

    2002-01-01

    Extirpation of the stomach accounts for 55.5% of all radical surgery for gastric cancer. Five hundred and sixty-two operations with creation of invaginated esophageal-intestinal (gastric) anastomosis were performed. The surgical technique is presented, its positive points are demonstrated. Main advantages of the invaginated anastomosis are physiologic function in postoperative period and a decreased rate of sutures insufficiency. Complications after extirpation and proximal resection of the stomach were seen in 17.6% cases, 5.9% patients died. Insufficiency of anastomosis sutures was in 8 (14%) patients, 4 (0.7%) of them died. PMID:12449573

  15. HtrA1 expression associated with the occurrence and development of esophageal cancer

    PubMed Central

    2012-01-01

    Background The purposes of this study were to measure both the mRNA and protein expression levels of high-temperature requirement serine peptidase 1 (HtrA1) in human esophageal cancer tissues and their adjacent, comparatively normal esophageal tissues. Methods The expression levels of HtrA1 mRNA and protein in both tissue types were measured by semi-quantitative RT-PCR (reverse transcription-polymerase chain reaction) and Western blotting. The clinical and pathological correlation between HtrA1 expression levels and the occurrence and development of esophageal cancer was analyzed. Results The expression levels of HtrA1 mRNA and protein in esophageal carcinoma were significantly lower than the levels expressed in their adjacent normal esophageal tissue (p?esophageal tumor cells expressed lower HtrA1 mRNA and protein expression levels (p?stages (I-II) had significantly higher HtrA1 mRNA and protein expression levels than did patients with tumors in mid-to-late pathological stages (III-IV) (p?esophageal cancer. PMID:22935172

  16. Significance of iron(II,III) hydroxycarbonate green rust in arsenic remediation using zerovalent iron in laboratory column tests.

    PubMed

    Su, Chunming; Puls, Robert W

    2004-10-01

    We examined the corrosion products of zerovalent iron used in three column tests for removing arsenic from water under dynamic flow conditions. Each column test lasted 3-4 months using columns consisting of a 10.3-cm depth of 50:50 (w:w, Peerless iron:sand) in the middle and a 10.3cm depth of a sediment from Elizabeth City, NC, in both upper and lower portions of the 31-cm-long glass column (2.5 cm in diameter). The feeding solutions were 1 mg of As(V) L(-1) + 1 mg of As(III) L(-1) in 7 mM NaCl + 0.86 mM CaSO4 with or without added phosphate (0.5 or 1 mg of P L(-1)) and silicate (10 or 20 mg of Si L(-1)) at pH 6.5. Iron(II,III) hydroxycarbonate green rust (or simply, carbonate green rust) and magnetite were the major iron corrosion products identified with X-ray diffraction for the separated fractions (5 and 1 min sedimentation and residual). The presence of carbonate green rust was confirmed by scanning electron microscopy (hexagonal morphology) and FTIR-photoacoustic spectroscopy (interlayer carbonate stretching mode at 1352-1365 cm(-1)). X-ray photoelectron spectroscopy investigation revealed the presence of predominantly As(V) at the surface of corroded iron particles despite the fact that the feeding solution in contact with Peerless iron contained more As(III) than As(V) as a result of a preferential uptake of As(V) over As(III) by the Elizabeth City sediment. Extraction of separated corrosion products with 1.0 M HCI showed that from 86 to 96% of the total extractable As (6.9-14.6 g kg(-1)) was in the form of As(V) in agreement with the XPS results. Combined microscopic and macroscopic wet chemistry results suggest that sorbed As(III) was partially oxidized by the carbonate green rust at the early stage of iron corrosion. The column experiments suggest that either carbonate green rust is kinetically favored or is thermodynamically more stable than sulfate green rust in the studied Peerless iron corrosion systems. PMID:15506221

  17. Dosimetric correlations of acute esophagitis in lung cancer patients treated with radiotherapy

    SciTech Connect

    Takeda, Ken [Department of Radiology, National Hospital Organization Sendai Medical Center, Sendai (Japan)]. E-mail: takedak41@yahoo.co.jp; Nemoto, Kenji [Department of Radiation Oncology, Tohoku University School of Medicine, Sendai (Japan); Saito, Haruo [Department of Radiology, National Hospital Organization Sendai Medical Center, Sendai (Japan); Ogawa, Yoshihiro [Department of Radiation Oncology, Tohoku University School of Medicine, Sendai (Japan); Takai, Yoshihiro [Department of Radiation Oncology, Tohoku University School of Medicine, Sendai (Japan); Yamada, Shogo [Department of Radiation Oncology, Tohoku University School of Medicine, Sendai (Japan)

    2005-07-01

    Purpose: To evaluate the factors associated with acute esophagitis in lung cancer patients treated with thoracic radiotherapy. Methods and Materials: We examined 35 patients with non-small-cell lung cancer (n = 27, 77%) and small-cell lung cancer (n = 8, 23%) treated with thoracic radiotherapy between February 2003 and November 2004. The median patient age was 70 years (range, 50-83 years). The disease stage was Stage I in 2 patients (6%), Stage II in 1 (3%), Stage IIIa in 10 (28%), Stage IIIb in 9 (26%), and Stage IV in 9 (26%); 4 patients (11%) had recurrent disease after surgery. A median dose of 60 Gy (range, 50-67 Gy) was given to the isocenter and delivered in single daily fractions of 1.8 or 2 Gy. With heterogeneity corrections, the median given dose to the isocenter was 60.3 Gy (range, 49.9-67.2 Gy). Of the 35 patients, 30 (86%) received concurrent chemotherapy consisting of a platinum agent, cisplatin or carboplatin, combined with paclitaxel in 18 patients (52%), irinotecan hydrochloride in 7 (20%), vincristine sulfate and etoposide in 2 (5%), vinorelbine ditartrate in 1 (3%), etoposide in 1 (3%), and docetaxel in 1 patient (3%). Three of these patients underwent induction therapy with cisplatin and irinotecan hydrochloride, administered before thoracic radiotherapy, and concurrent chemotherapy. Esophageal toxicity was graded according to the Radiation Therapy Oncology Group criteria. The following factors were analyzed with respect to their association with Grade 1 or worse esophagitis by univariate and multivariate analyses: age, gender, concurrent chemotherapy, chemotherapeutic agents, maximal esophageal dose, mean esophageal dose, and percentage of esophageal volume receiving >10 to >65 Gy in 5-Gy increments. Results: Of the 35 patients, 25 (71%) developed acute esophagitis, with Grade 1 in 20 (57%) and Grade 2 in 5 (14%). None of the patients had Grade 3 or worse toxicity. The most significant correlation was between esophagitis and percentage of esophageal volume receiving >35 Gy on univariate (p = 0.002) and multivariate (p = 0.018) analyses. Conclusion: The percentage of esophageal volume receiving >35 Gy was the most statistically significant factor associated with mild acute esophagitis.

  18. Layer-specific noradrenergic modulation of inhibition in cortical layer II/III.

    PubMed

    Salgado, Humberto; Garcia-Oscos, Francisco; Patel, Ankur; Martinolich, Laura; Nichols, Justin A; Dinh, Lu; Roychowdhury, Swagata; Tseng, Kuei-Yuan; Atzori, Marco

    2011-01-01

    Norepinephrine (NE) is released in the neocortex after activation of the locus coeruleus of the brain stem in response to novel, salient, or fight-or-flight stimuli. The role of adrenergic modulation in sensory cortices is not completely understood. We investigated the possibility that NE modifies the balance of inhibition acting on 2 different ?-aminobutyric acid (GABA)ergic pathways. Using patch-clamp recordings, we found that the application of NE induces an ?(1) adrenergic receptor-mediated decrease of the amplitude of inhibitory postsynaptic currents (IPSCs) evoked by stimulation of layer I (LI-eIPSCs) and a ? and ?(2) receptor-mediated increase in the amplitude of IPSCs evoked by stimulation of layer II/III (LII/III-eIPSCs). Analysis of minimal stimulation IPSCs, IPSC kinetics, and sensitivity to the GABA(A) receptor subunit-selective enhancer zolpidem corroborated the functional difference between LI- and LII/III-eIPSCs, suggestive of a distal versus somatic origin of LI- and LII/III-eIPSCs, respectively. These findings suggest that NE shifts the balance between distal and somatic inhibition to the advantage of the latter. We speculate that such shift modifies the balance of sensory-specific and emotional information in the integration of neural input to the upper layers of the auditory cortex. PMID:20466749

  19. Equatorial ?-stacking interactions in diruthenium (II,III) tetracarboxylate complexes containing extended ?-systems

    NASA Astrophysics Data System (ADS)

    O'Rourke, Natasha F.; Ronaldson, Michael; Stanley Cameron, T.; Wang, Ruiyao; Aquino, Manuel A. S.

    2013-11-01

    The synthesis of three new valent-averaged tetracarboxylatodiruthenium (II,III) complexes, [Ru2(1-naphthylacetate)4(H2O)2](PF6)?4THF, 1?4THF, [Ru2(2-naphthoate)4(THF)2](PF6)?3THF, 2?3THF, and [Ru2(coumarin-3-carboxylate)4(MeOH)2](PF6)?MeOH?H2O, 3?MeOH?H2O, was accomplished using a well documented carboxylate exchange reaction. All three complexes were thoroughly characterized using infrared and UV-Vis spectroscopies, elemental analysis and X-ray diffraction. Due to the extended ?-systems present, two of the complexes, 2?3THF and 3?MeOH?H2O, display extensive ?-stacking in two dimensions, with similar interactions notably absent in 1?4THF due to the perpendicular orientation of the naphthyl rings. Modest H-bonding is seen in complexes 1?4THF and 3?MeOH?H2O. As these types of complexes are noted secondary building units (SBU's) in the construction of metal-organic frameworks (MOF's), the significance of these interactions in stabilizing even larger, supramolecular structures, are noted.

  20. Treatment of advanced esophageal cancer

    SciTech Connect

    Kelsen, D.

    1982-12-01

    When radiation therapy is used for palliation of obstruction in patients with advanced esophageal carcinoma, an improvement in dysphagia can be expected in approximately 50% of patients. Major objective responses have rarely been quantitied but, in one study, were seen in 33% patients. Recurrence of dysphagia is usually seen within 2-6 months of treatment. Radiation toxicities and complications, even when used with palliative intent, can be substantial and include esophagitis, tracheoesophageal or esophageal-aortic fistula, mediastinitis, hemorrhage, pneumonitis, and myelosuppression. (JMT)

  1. Pharmacologic treatments for esophageal disorders.

    PubMed

    Blackshaw, L Ashley; Bordin, Dmitry S; Brock, Christina; Brokjaer, Anne; Drewes, Asbjørn Mohr; Farmer, Adam D; Krarup, Anne Lund; Lottrup, Christian; Masharova, Antonina A; Moawad, Fouad J; Olesen, Anne Estrup

    2014-09-01

    The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the role for ketamine and other alternative treatments in esophageal disorders; the use of linaclotide in the treatment of esophageal pain; the alginate test as a diagnostic criterion in gastroesophageal reflux disease (GERD); the use of baclofen in treatment of GERD; the effects of opioids on the esophagus; the use of antagonists on the receptor level in GERD; the effect of local formulation of drugs on the esophageal mucosa; and the use of electroencephalographic fingerprints to predict the effect of pharmacological treatment. PMID:25266012

  2. White specks in the esophageal mucosa: an endoscopic manifestation of non-reflux eosinophilic esophagitis in children

    Microsoft Academic Search

    Joel R Lim; Sandeep K Gupta; Joseph M Croffie; Marian D Pfefferkorn; Jean P Molleston; Mark R Corkins; Mary M Davis; Philip P Faught; Steven J Steiner; Joseph F Fitzgerald

    2004-01-01

    BackgroundWhite specks in the esophageal mucosa have been observed in children with eosinophilic esophagitis. The aim of this study was to determine the relationship between white specks in the esophageal mucosa and allergic (non-reflux) eosinophilic esophagitis.

  3. Interaction between gold (III) chloride and potassium hexacyanoferrate (II\\/III)—Does it lead to gold analogue of Prussian blue?

    Microsoft Academic Search

    S. Harish; James Joseph; K. L. N. Phani

    2011-01-01

    Prussian blue analogues are a class of compounds formed by the reaction between metal salt and potassium hexacyanoferrate (II\\/III). In our earlier report, the formation of Au@Prussian blue nano-composite was noticed on potential cycling the glassy carbon electrode in a medium containing gold (III) chloride and potassium hexacyanoferrate (III). Hence in this work, the formation of gold hexacyanoferrate was attempted

  4. Spectroscopic and quantum chemical study of the structure of a new paramagnetic dimeric palladium(II,III) complex with creatine

    NASA Astrophysics Data System (ADS)

    Mitewa, Mariana; Enchev, Venelin; Bakalova, Tatyana

    2002-05-01

    The structure and coordination mode of the newly synthesized dimeric paramagnetic Pd(II,III) complex are studied using magneto-chemical, EPR and IR spectroscopic methods. In order to perform reliable assignment of the IR bands, the structure and IR spectrum of the free creatine were calculated using ab initio method. For calculation of the configuration of its deprotonated and doubly deprotonated forms the semiempirical AM1 method was used.

  5. The Raman spectra of ice (Ih, II, III, V, VI and IX) as functions of pressure and temperature

    Microsoft Academic Search

    B. Minceva-Sukarova; W. F. Sherman; G. R. Wilkinson

    1984-01-01

    The Raman spectra of various forms of ice Ih, II, III, IX, V and VI of H2O, D2O, H218O and small percentages of HOD in both D2O and H2O have been recorded in their true regions of stability. The high-pressure low-temperature Raman cell used for this work is described. The influence of pressure on the OH and OD stretching modes

  6. Esophageal stenting in cancer therapy.

    PubMed

    Goenka, Mahesh Kumar; White, Russell E

    2014-09-01

    The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on nutritional support during chemoradiation, esophageal stents before surgery, and stenting the cervical esophagus. PMID:25266018

  7. Drugs Approved for Esophageal Cancer

    Cancer.gov

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for esophageal cancer. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

  8. Drug-induced esophageal strictures.

    PubMed Central

    Bonavina, L; DeMeester, T R; McChesney, L; Schwizer, W; Albertucci, M; Bailey, R T

    1987-01-01

    A retrospective study of 55 patients with a benign esophageal stricture showed that in 11 patients (20%) the cause was a drug-induced lesion due to potassium chloride (3), tetracyclines (3), aspirin (2), vitamin C (1), phenytoin (1), and quinidine (1). Five of the 11 patients would have been diagnosed as having a reflux etiology of their stricture if 24-hour esophageal pH monitoring was not performed. Six patients responded to dilatation and five patients required resection or bypass. A prospective study of 18 asymptomatic volunteers showed a high incidence of esophageal lodgment of a radiolabeled medicinal capsule, with subsequent dissolution and release of the isotope. This occurred most frequently in elderly subjects and was reduced by increasing the volume of water chaser. The sites of lodgment correspond to the location of the observed strictures in the patient population. An in vitro study showed that, when the causative drugs were mixed with saliva, dissolution occurred within 60 minutes and was associated with significant changes in pH. These investigations show that drug-induced esophageal strictures are more common than previously appreciated, and can be confused with a reflux etiology. Diagnosis is suggested by a history of drug ingestion, location of the stricture, and a normal esophageal acid exposure on 24-hour pH monitoring. The severity of the esophageal injury is variable and requires dilatation to resection for therapy. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:3606243

  9. Hyperthermochemoradiotherapy and esophageal carcinoma

    SciTech Connect

    Sugimachi, K.; Inokuchi, K.

    1986-01-01

    Cancer of the esophagus still poses considerable treatment problems, with a poor 5-year survival rate after surgery, an even worse outlook after radiation and surgery, and a not very satisfactory response to chemotherapy. After several years of continued research, in 1983 we developed a Radio Frequency System with endotract electrode and thermosensors for administering hyperthermochemoradiotherapy to patients with carcinoma of the esophagus. Results in 129 patients are discussed. Immediate improvement of subjective complaints and decrease or elimination of the cancer lesion are so distinct that this treatment, by means of an endotract antenna, shows promise as a modality for esophageal lesions and may find application in diseases such as colorectal cancer or carcinoma of the uterine cervix.

  10. Hyperthermochemoradiotherapy and esophageal carcinoma.

    PubMed

    Sugimachi, K; Inokuchi, K

    1986-01-01

    Cancer of the esophagus still poses considerable treatment problems, with a poor 5-year survival rate after surgery, an even worse outlook after radiation and surgery, and a not very satisfactory response to chemotherapy. After several years of continued research, in 1983 we developed a Radio Frequency System with endotract electrode and thermosensors for administering hyperthermochemoradiotherapy to patients with carcinoma of the esophagus. Results in 129 patients are discussed. Immediate improvement of subjective complaints and decrease or elimination of the cancer lesion are so distinct that this treatment, by means of an endotract antenna, shows promise as a modality for esophageal lesions and may find application in diseases such as colorectal cancer or carcinoma of the uterine cervix. PMID:2430326

  11. Eosinophilic esophagitis in adults: An emerging problem with unique esophageal features

    Microsoft Academic Search

    Jon W Potter; Kia Saeian; Benson T Massey; Richard A Komorowski; Reza Shaker; Walter J Hogan

    2004-01-01

    BackgroundEosinophilic esophagitis is an inflammatory condition in which there is dense eosinophilic infiltration of the surface lining of the esophagus. Reports of eosinophilic esophagitis pertain almost exclusively to pediatric populations. However, eosinophilic esophagitis is emerging as a clinical affliction of adults. This report describes the clinical and endoscopic findings of eosinophilic esophagitis in the largest cohort of adult patients reported

  12. Skip navigation Wireless System Tracks Esophageal Reflux

    E-print Network

    Chiao, Jung-Chih

    better testing than catheters now used MedlinePlus: Wireless System Tracks Esophageal Reflux URL: http://www.nlm.nih.gov Esophageal Reflux URL: http://www.nlm.nih.gov/medlineplus/news/fullstory_51164.html #12;

  13. Endoscopic and clinicopathological patterns of esophageal cancer in Tanzania: experiences from two tertiary health institutions

    PubMed Central

    2013-01-01

    Background Esophageal cancer is one of the most serious gastrointestinal cancer worldwide, owing to its rapid development and fatal prognoses in most cases. There is a paucity of published data regarding esophageal cancer in Tanzania and the study area in particular. This study was conducted to describe the endoscopic and clinicopathological patterns of esophageal cancer in this part of the world. The study provides baseline local data for future comparison. Methods This was a retrospective study of histologically confirmed cases of esophageal cancer seen at Bugando Medical Center and Muhimbili National Hospital between March 2008 and February 2013. Data were retrieved from medical record computer database and analyzed using SPSS computer software version 17.0. Results A total of 328 esophageal cancer patients were enrolled in the study, representing 25.3% of all malignant gastrointestinal tract tumors. The male to female ratio was 2.2:1. The median age of patients at presentation was 47 years. The majority of patients (86.6%) were peasants coming from the rural areas. Smoking and alcohol consumption were documented in 74.7% and 61.6% of patients respectively. Family history of esophageal cancer was reported in 4.6% of cases. The majority of patients (81.7%) presented late with advanced stage of cancer. Progressive dysphagia and weight loss were the most common presenting symptoms occurring in all patients. The middle third esophagus (58.5%) was the most frequent anatomical site for esophageal cancer followed by lower third (27.4%) and upper third esophagus (10.4%). Squamous cell carcinoma (96.0%) was the most common histopathological type. Adenocarcinoma occurred in 13 (4.0%) patients. TNM staging was documented in only 104 (31.7%) patients. Of these, 102(98.1%) patients were diagnosed with advanced esophageal cancer (Stages III and IV). According to tumor grading, most of tumors were moderately differentiated accounting for 56.1% of cases. Distant metastasis was documented in 43.3% of patients. Conclusion Esophageal cancer is not uncommon in this region and shows a trend towards a relative young age at presentation and the majority of patients present late with advanced stage. There is a need for screening of high-risk populations and detecting esophageal cancer at an early stage in order to improve chances for successful treatment and survival. PMID:24094270

  14. The Pathophysiology of Eosinophilic Esophagitis

    PubMed Central

    Raheem, Mayumi; Leach, Steven T.; Day, Andrew S.; Lemberg, Daniel A.

    2014-01-01

    Eosinophilic esophagitis (EoE) is an emerging disease characterized by esophageal eosinophilia (>15eos/hpf), lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast-cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with transforming growth factor-? to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE. PMID:24910846

  15. A Treatment Option for Esophageal Intramural Pseudodiverticulosis

    PubMed Central

    Jodorkovsky, Daniela

    2014-01-01

    Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition often presenting with esophageal strictures. Treatment is often limited to endoscopic dilatation and treatment of the underlying esophageal pathology. We present a case of a patient with longstanding GERD on famotidine (she experienced anaphylaxis with proton pump inhibitors [PPIs]) who presented with dysphagia and weight loss. Work-up revealed a diagnosis of EIPD with a 5-mm mid-esophageal stricture. Therapy with dilatation was unsuccessful until the addition of sucralfate, after which dilatation was successful and symptoms resolved. In patients who are unable to take PPIs, the addition of sucralfate may enhance the success of dilatations of esophageal strictures and EIPD.

  16. Sloughing Esophagitis: A Not So Common Entity

    PubMed Central

    Akhondi, Hossein

    2014-01-01

    BACKGROUND: Sloughing esophagitis, also known as esophagitis dissecans superficialis, is a very rare and underdiagnosed entity with unknown incidence rate. It can be associated with bullous dermatoses and medications such as central nervous system depressants and those causing esophageal injury. CASE REPORT: A 55-years-old woman was recovering from renal failure due to rhabdomyolysis when she developed dysphagia and odynophagia. Esophagogastroduodenoscopy with biopsy was performed for suspected bullous pemphigus and confirmed sloughing esophagitis. She improved with intravenous steroids. CONCLUSIONS: Sloughing Esophagitis should enter our differential diagnosis more frequently. It is mostly a benign, self-limiting process but when associated with bullous dermatoses will require steroid treatment. PMID:25598761

  17. Microwave analysis of mortar prepared with type I/II, III and V cement and subjected to cyclical chloride exposure

    NASA Astrophysics Data System (ADS)

    Case, J. T.; Zoughi, R.; Donnell, K.; Hughes, D.; Kurtis, K. E.

    2002-05-01

    The presence of a sufficient concentration of chloride ions at the steel/concrete interface can lead to the initiation of corrosion in reinforced concrete structures. To this end, a set of near-field microwave nondestructive testing experiments were conducted using three mortar specimens made with three different cements: ASTM Type I/II, III and V. These specimens were cyclically exposed to a chloride solution and their daily microwave reflection properties were measured. These measurements indicate that the technique may be able to differentiate between the specimens.

  18. Photodynamic therapy for esophageal cancer.

    PubMed

    Yano, Tomonori; Hatogai, Ken; Morimoto, Hiroyuki; Yoda, Yusuke; Kaneko, Kazuhiro

    2014-03-01

    Photodynamic therapy (PDT) is a treatment that uses a photosensitizing drug that is administered to the patient, localized to a tumor, and then activated with a laser to induce a photochemical reaction to destroy the cell. PDT using porfimer sodium followed by excimer dye laser irradiation is approved as a curative treatment for superficial esophageal cancer in Japan. While endoscopic submucosal dissection (ESD) is currently more popular for esophageal cancer, there is evidence to support PDT as an alternative treatment and as a salvage treatment for local failure after chemoradiotherapy (CRT). A photosensitizing agent has also been developed that requires a shorter sun shade period after administration, and studies are currently underway to establish an esophageal cancer indication for this next-generation PDT in Japan. PMID:25333005

  19. Photodynamic therapy for esophageal cancer

    PubMed Central

    Hatogai, Ken; Morimoto, Hiroyuki; Yoda, Yusuke; Kaneko, Kazuhiro

    2014-01-01

    Photodynamic therapy (PDT) is a treatment that uses a photosensitizing drug that is administered to the patient, localized to a tumor, and then activated with a laser to induce a photochemical reaction to destroy the cell. PDT using porfimer sodium followed by excimer dye laser irradiation is approved as a curative treatment for superficial esophageal cancer in Japan. While endoscopic submucosal dissection (ESD) is currently more popular for esophageal cancer, there is evidence to support PDT as an alternative treatment and as a salvage treatment for local failure after chemoradiotherapy (CRT). A photosensitizing agent has also been developed that requires a shorter sun shade period after administration, and studies are currently underway to establish an esophageal cancer indication for this next-generation PDT in Japan. PMID:25333005

  20. [Exfoliative esophagitis while taking dabigatran].

    PubMed

    Scheppach, Wolfgang; Meesmann, Malte

    2015-04-01

    History | A 77-year-old woman was admitted with severe chest pain, heartburn, dysphagia and odynophagia. She had been on dabigatran for 13 months due to atrial fibrillation and arterial hypertension. Investigations and findings | Endoscopy of the esophagus revealed sloughing of mucosal casts, predominantly in the upper half of the organ. Treatment and course | The patient was placed on pantoprazol, local anaesthetic antacid and i.?v. fluids. Dabigatran was discontinued. The symptoms disappeared within 3 days. Control endoscopy after 12 days showed complete healing of the esophageal mucosa. Conclusion | The intake of dabigatran was associated with exfoliative esophagitis, possibly due to caustic tissue damage by prolonged drug contact. PMID:25826037

  1. Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia.

    PubMed

    Kassabian, Sirvart; Baez-Socorro, Virginia; Sferra, Thomas; Garcia, Reinaldo

    2014-12-21

    Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE. PMID:25548504

  2. Esophageal manifestations of celiac disease.

    PubMed

    Lucendo, A J

    2011-09-01

    Celiac disease (CD) may often be associated with various motor disorders affecting the different segments of the digestive tract, including the esophagus. Although it has not been universally reported, some available evidences indicate that pediatric and adult celiac patients could manifest a higher frequency of esophagitis and gastroesophageal reflux disease-related symptoms compared to nonceliac patients. In addition, several published studies have consistently shown the efficacy of a gluten-free diet in rapidly controlling esophageal symptoms and in preventing their recurrence. Since the participation of gluten in the esophageal symptoms of CD seems clear, its intimate mechanisms have yet to be elucidated, and several hypothesis have been proposed, including the specific immune alterations characterizing CD, the reduction in nutrient absorption determining the arrival of intact gluten to distal gastrointestinal segments, and various dysregulations in the function of gastrointestinal hormones and peptides. Recent studies have suggested the existence of a possible relationship between CD and eosinophilic esophagitis, which should be more deeply investigated. PMID:21438963

  3. Hypertrophic pyloric stenosis following repair of esophageal atresia and tracheo-esophageal fistula.

    PubMed

    Seguier-Lipszyc, Emmanuelle; Klin, Baruch

    2014-01-01

    Two cases of hypertrophic pyloric stenosis (HPS) developed after a few weeks of repair of an esophageal atresia and tracheo-esophageal fistula (EA and TEF). Both cases were dealt successfully with laparoscopic pyloromyotomy. PMID:26023501

  4. The Changing Face of Esophageal Cancer

    PubMed Central

    Melhado, Rachel E.; Alderson, Derek; Tucker, Olga

    2010-01-01

    The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction. PMID:24281163

  5. Fragility of the esophageal mucosa: A pathognomonic endoscopic sign of primary eosinophilic esophagitis?

    Microsoft Academic Search

    Alex Straumann; Livio Rossi; Hans-Uwe Simon; Pius Heer; Hans-Peter Spichtin; Christoph Beglinger

    2003-01-01

    Background: Primary eosinophilic esophagitis, a chronic inflammatory disorder of the esophagus, evokes recurrent dysphagia. Endoscopy is often unremarkable, and no consensus exists regarding management of resultant dysphagia. The response of a series of patients with primary eosinophilic esophagitis to dilation is reported together with a description of a possibly pathognomonic sign: fragile esophageal mucosa, for which the term “crêpe-paper” mucosa

  6. Characteristics of brain metastases from esophageal carcinoma

    PubMed Central

    Yamamoto, Takahiro; Kuroda, Jun-ichiro; Takezaki, Tatsuya; Shinojima, Naoki; Hide, Takuichiro; Makino, Keishi; Nakamura, Hideo; Yano, Shigetoshi; Nishi, Toru; Kuratsu, Jun-ichi

    2014-01-01

    Background: Esophageal carcinoma (EC) is a major malignancy with a poor prognosis. Although esophageal cancers rarely metastasize to the brain, the number of patients diagnosed with brain metastases (BM) from EC is steadily increasing. Therefore, the risk factors for BM from EC should be known. Here we reviewed our experiences and the previous literature regarding BM from EC. Methods: Between 2000 and 2013, we retrospectively reviewed the clinical features and neurological findings of 19 patients diagnosed with and treated for BM from EC to determine the clinical risk factors and features. Results: In all patients, the lesions were partially or completed located in the thoracic esophagus, and the average size of the EC lesion at diagnosis was 5.8 ± 2.9 cm, which was smaller than the previously reported size of EC lesions accompanied by BM. Patients without lung metastases were more common than those with lung metastases. The lesions in the 13 patients included squamous cell carcinoma (SqCC) in 9 (69.2%) and small cell carcinoma (SmCC) in 3 (23.0%). Six patients were not examined. Although there was no trend toward a higher incidence of BM in patients with adenocarcinoma and SqCC, this trend was observed in patients with SmCC. Excluding a single patient with SmCC, all patients had beyond stage III disease at EC diagnosis. Conclusions: Our study suggests that BM can occur in patients with EC lesions smaller than those previously reported; moreover, SmCC may be a risk factor for BM from EC. PMID:25317352

  7. Corrosive Esophagitis Caused by Ingestion of Picosulfate

    PubMed Central

    Seo, Jae Yong; Kang, Ho Suk; Kim, Seong Eun; Park, Ji Won; Moon, Sung Hoon; Kim, Jong Hyeok; Park, Choong Kee

    2015-01-01

    Corrosive esophagitis is characterized by caustic injury due to the ingestion of chemical agents, mainly alkaline substances such as detergents. Esophageal bleeding, perforation, or stricture can be worsened by high-degree corrosive esophagitis. Picosulfate is a commonly used laxative frequently administered for bowel preparation before colonoscopy or colon surgery. Picosulfate powder should be completely dissolved in water before ingestion because the powder itself may cause chemical burning of the esophagus and stomach. Here, we report a case of corrosive esophagitis due to the ingestion of picosulfate powder that was not completely dissolved in water. PMID:25674529

  8. Porphyrin-Sensitized Solar Cells with Cobalt (II/III)-Based Redox Electrolyte Exceed 12 Percent Efficiency

    NASA Astrophysics Data System (ADS)

    Yella, Aswani; Lee, Hsuan-Wei; Tsao, Hoi Nok; Yi, Chenyi; Chandiran, Aravind Kumar; Nazeeruddin, Md. Khaja; Diau, Eric Wei-Guang; Yeh, Chen-Yu; Zakeeruddin, Shaik M.; Grätzel, Michael

    2011-11-01

    The iodide/triiodide redox shuttle has limited the efficiencies accessible in dye-sensitized solar cells. Here, we report mesoscopic solar cells that incorporate a Co(II/III)tris(bipyridyl)-based redox electrolyte in conjunction with a custom synthesized donor-?-bridge-acceptor zinc porphyrin dye as sensitizer (designated YD2-o-C8). The specific molecular design of YD2-o-C8 greatly retards the rate of interfacial back electron transfer from the conduction band of the nanocrystalline titanium dioxide film to the oxidized cobalt mediator, which enables attainment of strikingly high photovoltages approaching 1 volt. Because the YD2-o-C8 porphyrin harvests sunlight across the visible spectrum, large photocurrents are generated. Cosensitization of YD2-o-C8 with another organic dye further enhances the performance of the device, leading to a measured power conversion efficiency of 12.3% under simulated air mass 1.5 global sunlight.

  9. Successful Use of Esophageal Stent Placement to Treat a Postoperative Esophageal Stricture in a Toddler

    PubMed Central

    Gebrail, Rami

    2014-01-01

    Esophageal atresia (EA) is the most common type of gastrointestinal atresia. The most common variant (type C) consists of a blind esophageal pouch with a fistula between the trachea and the distal esophagus. Surgical repair can be complicated by the development of benign stricture. Most strictures are amenable to dilation, but refractory strictures may require surgical intervention. A 24-month-old boy born with tracheoesophageal fistula and EA underwent surgical repair on day 1 of life. He developed esophageal stricture that responded to esophageal stent placement. Endoscopic biliary accessories can be safely used to dilate refractory esophageal strictures in children, and should be considered prior to seeking other complex alternatives.

  10. The 'skinny' on eosinophilic esophagitis.

    PubMed

    Katzka, David A

    2015-02-01

    Eosinophilic esophagitis--a disease that even most physicians know little about--is becoming increasingly common. Often starting in childhood with eating difficulties and symptoms of gastroesophageal reflux disease, it progresses with increasing inflammation, fibrosis, and strictures until the esophagus is visibly narrowed on radiography. Early recognition and treatment with an allergen-avoidance diet and steroids are critical to avoiding or postponing complications. PMID:25897596

  11. Esophageal metastasis of breast carcinoma

    Microsoft Academic Search

    Yasuo Wada; Nobuko Harada; Kazuhiro Ohara; Hironori Kawata; Hironori Iwasaki; Yuuichiro Kawamura; Takashi Gomi; Masahiro Ohtoshi; Yasuaki Nakashima

    2009-01-01

    Esophageal metastasis from primary breast cancer is an unusual manifestation. We recently treated a patient with dysphagia,\\u000a whose breast cancer had been treated in the distant past. A 70-year-old woman had been followed regularly in our outpatient\\u000a clinic for 14 years after her primary breast cancer treatment, with no apparent tumor recurrence. After 2 years absence, she\\u000a consulted our clinic with progressive

  12. The management of eosinophilic esophagitis.

    PubMed

    Greenhawt, Matthew; Aceves, Seema S; Spergel, Jonathan M; Rothenberg, Marc E

    2013-01-01

    Eosinophilic esophagitis (EoE) is a clinicopathologic, chronic esophageal inflammatory disease resistant to acid suppressive therapy and is associated with variable symptoms indicative of upper gastrointestinal dysfunction. Per current guidelines established by The International Group of Eosinophil Researchers (TIGERS), the diagnosis is made in symptomatic patients after a biopsy that confirms a peak eosinophil level of ?15 eosinophils/high-powered field (HPF). The esophagus is distinguished by pronounced tissue eosinophilia in which dietary antigens are key inciting factors for disease pathogenesis; EoE being reversed by elimination of triggering food allergens suggests that the disease is mediated in part by allergic sensitization to foods. Moreover, experimental EoE in mice can be induced not only via food exposure but also via aeroallergen exposure. Consistent with an allergic etiology rather than an acid-induced esophagitis, swallowed glucocorticoids are effective for the treatment of EoE. Evaluation by an allergist is a recommended part of the diagnostic workup, especially for management of allergic comorbidities. Clinical practice for the evaluation of patients with EoE mainly relies on prick skin tests due to the ease and validation of these tests in the context of immediate hypersensitivity. However, both atopy patch testing and serum IgE testing have been used in EoE. Herein, we reviewed the basic clinical features of EoE with a focus on the approach to diagnosing causative food allergens and to dietary therapy. PMID:24565538

  13. High Resolution Microendoscopy for Quantitative Diagnosis of Esophageal Neoplasia

    NASA Astrophysics Data System (ADS)

    Shin, Dongsuk

    Esophageal cancer is the eighth most common cancer in the world. Cancers of the esophagus account for 3.8% of all cases of cancers, with approximately 482,300 new cases reported in 2008 worldwide. In the United States alone, it is estimated that approximately 18,000 new cases will be diagnosed in 2013, and 15,210 deaths are expected. Despite advances in surgery and chemoradiation therapy, these advances have not led to a significant increase in survival rates, primarily because diagnosis often at an advanced and incurable stage when treatment is more difficult and less successful. Accurate, objective methods for early detection of esophageal neoplasia are needed. Here, quantitative classification algorithms for high resolution miscroendoscopic images were developed to distinguish between esophageal neoplastic and non-neoplastic tissue. A clinical study in 177 patients with esophageal squamous cell carcinoma (ESCC) was performed to evaluate the diagnostic performance of the classification algorithm in collaboration with the Mount Sinai Medical Center in the United States, the First Hospital of Jilin University in China, and the Cancer Institute and Hospital, the Chinese Academy of Medical Science in China. The study reported a sensitivity and specificity of 93% and 92%, respectively, in the training set, 87% and 97%, respectively, in the test set, and 84% and 95%, respectively, in an independent validation set. Another clinical study in 31 patients with Barrett's esophagus resulted in a sensitivity of 84% and a specificity of 85%. Finally, a compact, portable version of the high resolution microendoscopy (HRME) device using a consumer-grade camera was developed and a series of biomedical experimental studies were carried out to assess the capability of the device.

  14. A Unique Case of a Patient with Rectal Cancer Who Developed Benign Esophageal Stenosis after Localized Rectal Radiation and Systemic Chemotherapy

    PubMed Central

    Chahla, Elie; Cheesman, Antonio; Hammami, Muhammad; Taylor, Jason R.; Poddar, Nishant; Garrett, Robert W.; Alkaade, Samer

    2015-01-01

    Acute esophagitis and esophageal strictures typically occur after local radiation therapy to the thoracic field. Toxicity is usually limited to the field of radiation and potentially augmented by concomitant use of chemotherapy, however esophageal stricturing due to chemotherapy alone is exceedingly rare. Gastrointestinal toxicity has been previously reported in the setting of 5-fluorouracil (5-FU)-based chemotherapy with abnormal thymidylate synthase or dihydropyrimidine dehydrogenase activities. We present a unique case of isolated chemotherapy-induced esophageal stricture in the setting of stage IIIa rectal adenocarcinoma which presented shortly after initiation of treatment with 5-FU-based chemotherapy in a patient with normal thymidylate synthase and dihydropyrimidine dehydrogenase assays. These findings prompt further investigation of pathways and potential risk factors leading to esophageal toxicity in patients treated with 5-FU-based chemotherapy. PMID:25802497

  15. Promoter methylation of HIN-1 in the progression to esophageal squamous cancer.

    PubMed

    Guo, Mingzhou; Ren, Jingli; Brock, Malcolm V; Herman, James G; Carraway, Hetty E

    2008-11-01

    HIN-1 (High in normal-1) is a tumor suppressor gene that is highly expressed in many epithelial tissues, including breast lung, trachea, pancreas, prostrate and salivary gland. Inactivation of HIN-1 expression by promoter methylation is frequent in many epithelial carcinomas and carcinoma-in-situ, including breast, lung and nasopharyngeal. Because HIN-1 silencing commences at an early stage of malignant transformation in these tissues, it may be a useful marker for tumor presence. The status of HIN-1 regulation in esophageal cancer has not been previously reported. Thus, we analyzed 18 esophageal cancer cell lines for HIN-1 expression and methylation by reverse transcription PCR (RT-PCR) and methylation specific PCR (MSP). HIN-1 gene silencing and promoter methylation was present in 13 (72%) of the cell lines. Bisulfite-treated sequencing confirmed the methylation status in cell lines and demonstrated dense methylation of HIN-1 throughout the promoter region. Epigenetic changes of HIN-1 were examined throughout the progression of carcinogenesis in esophageal squamous lesions through analysis of archived surgical specimens from patients with normal esophageal mucosa (n = 17), grade I dysplasia (n = 39), grade II dysplasia (n = 12), grade III dysplasia (n = 9), and invasive squamous esophageal cancer (n = 126). Methylation of HIN-1 was present in 0% of normal mucosa, 31% of grade I dysplasia, 33% of grade II dysplasia, 44% of grade III dysplasia, and 50% of esophageal cancer specimens analyzed. These studies demonstrate HIN-1 silencing is associated with dense promoter region hypermethylation in esophageal cancer and suggest that methylation of HIN-1 is an early event in dysplastic transformation. PMID:19098448

  16. Acid Reflux Directly Causes Sleep Disturbances in Rat with Chronic Esophagitis

    PubMed Central

    Nakahara, Kenichi; Fujiwara, Yasuhiro; Tsukahara, Takuya; Yamagami, Hirokazu; Tanigawa, Tetsuya; Shiba, Masatsugu; Tominaga, Kazunari; Watanabe, Toshio; Urade, Yoshihiro; Arakawa, Tetsuo

    2014-01-01

    Background & Aims Gastroesophageal reflux disease (GERD) is strongly associated with sleep disturbances. Proton pump inhibitor (PPI) therapy improves subjective but not objective sleep parameters in patients with GERD. This study aimed to investigate the association between GERD and sleep, and the effect of PPI on sleep by using a rat model of chronic acid reflux esophagitis. Methods Acid reflux esophagitis was induced by ligating the transitional region between the forestomach and the glandular portion and then wrapping the duodenum near the pylorus. Rats underwent surgery for implantation of electrodes for electroencephalogram and electromyogram recordings, and they were transferred to a soundproof recording chamber. Polygraphic recordings were scored by using 10-s epochs for wake, rapid eye movement sleep, and non-rapid eye movement (NREM) sleep. To examine the role of acid reflux, rats were subcutaneously administered a PPI, omeprazole, at a dose of 20 mg/kg once daily. Results Rats with reflux esophagitis presented with several erosions, ulcers, and mucosal thickening with basal hyperplasia and marked inflammatory infiltration. The reflux esophagitis group showed a 34.0% increase in wake (232.2±11.4 min and 173.3±7.4 min in the reflux esophagitis and control groups, respectively; p<0.01) accompanied by a reduction in NREM sleep during light period, an increase in sleep fragmentation, and more frequent stage transitions. The use of omeprazole significantly improved sleep disturbances caused by reflux esophagitis, and this effect was not observed when the PPI was withdrawn. Conclusions Acid reflux directly causes sleep disturbances in rats with chronic esophagitis. PMID:25215524

  17. Temporal evolution in caveolin 1 methylation levels during human esophageal carcinogenesis

    PubMed Central

    2014-01-01

    Background Esophageal cancer ranks eighth among frequent cancers worldwide. Our aim was to investigate whether and at which neoplastic stage promoter hypermethylation of CAV1 is involved in human esophageal carcinogenesis. Methods Using real-time quantitative methylation-specific PCR (qMSP), we examined CAV1 promoter hypermethylation in 260 human esophageal tissue specimens. Real-time RT-PCR and qMSP were also performed on OE33 esophageal cancer cells before and after treatment with the demethylating agent, 5-aza-2’-deoxycytidine (5-Aza-dC). Results CAV1 hypermethylation showed highly discriminative ROC curve profiles, clearly distinguishing esophageal adenocarcinomas (EAC) and esophageal squamous cell carcinomas (ESCC) from normal esophagus (NE) (EAC vs. NE, AUROC?=?0.839 and p?esophageal carcinomas and is associated with early neoplastic progression in Barrett’s esophagus. PMID:24885118

  18. Treatment Option Overview (Esophageal Cancer)

    MedlinePLUS

    ... cancer cells. The following stages are used for squamous cell carcinoma of the esophagus: Stage 0 (High-grade Dysplasia) ... is also called high-grade dysplasia. Stage I squamous cell carcinoma of the esophagus Stage I is divided into ...

  19. Orthometalation of dibenzo[1,2]quinoxaline with ruthenium(II/III), osmium(II/III/IV), and rhodium(III) ions and orthometalated [RuNO](6/7) derivatives.

    PubMed

    Maity, Suvendu; Kundu, Suman; Saha Roy, Amit; Weyhermüller, Thomas; Ghosh, Prasanta

    2015-02-16

    A new family of organometallics of ruthenium(II/III), osmium(II/III/IV), and rhodium(III) ions isolated from C-H activation reactions of dibenzo[1,2]quinoxaline (DBQ) using triphenylphosphine, carbonyl, and halides as coligands is reported. The CN-chelate complexes isolated are trans-[Ru(III)(DBQ)(PPh3)2Cl2] (1), trans-[Ru(II)(DBQ)(CO)(PPh3)2Cl] (2), trans-[Os(III)(DBQ)(PPh3)2Br2] (3), trans-[Os(II)(DBQ)(PPh3)2(CO)Br] (4), and trans-[Rh(III)(DBQ)(PPh3)2Cl2] (5). Reaction of 1 with NO affords trans-[Ru(DBQ)(NO)(PPh3)2Cl]Cl (6(+)Cl(-)), isoelectronic to 2, with a byproduct, [Ru(NO)(PPh3)2Cl3] (7). Complexes 1-5 and 6(+) were characterized by elemental analyses, mass, IR, NMR, and electron paramagnetic resonance (EPR) spectra including the single-crystal X-ray structure determinations of 1-3 and 5. The Ru(III)-C, Ru(II)-C, Os(III)-C, and Rh(III)-C lengths are 2.049(2), 2.074(3), 2.105(16), and 2.012(3) Å in 1, 2, 3, and 5. In cyclic voltammetry, 2, 3, and 4 undergo oxidation at 0.59, 0.39, and 0.46 V, versus Fc(+)/Fc couple, to trans-[Ru(III)(DBQ)(CO)(PPh3)2Cl](+) (2(+)), trans-[Os(IV)(DBQ)(PPh3)2Br2](+) (3(+)), and trans-[Os(III)(DBQ)(CO)(PPh3)2Br](+) (4(+)) ions. Complex 3(+) incorporates an Os(IV)(d(4) ion)-C bond. The 6(+)/trans-[Ru(DBQ)(NO)(PPh3)2Cl] (6) reduction couple at -0.65 V is reversible. 2(+), 3(+), 4(+) and 6 were substantiated by spectroelectrochemical measurements, EPR spectra, and density functional theory (DFT) and time-dependent (TD) DFT calculations. The frozen-glass EPR spectrum of the electrogenerated 6 exhibits hyperfine couplings due to (99,101)Ru and (14)N nuclei. DFT calculations on trans-[Os(III)(DBQ)(PMe3)2Br2] (3(Me)), St = 1/2 and trans-[Os(IV)(DBQ)(PMe3)2Br2](+) (3(Me+)), St = 0, trans-[Ru(DBQ)(NO)(PMe3)2Cl](+) (6(Me+)), St = 0 and trans-[Ru(DBQ)(NO)(PMe3)2Cl] (6(Me)), St = 1/2, authenticated a significant mixing between dOs and ?aromatic* orbitals, which stabilizes M(II/III/IV)-C bonds and the [RuNO](6) and [RuNO](7) states, respectively, in 6(+) and 6, which is defined as a hybrid state of trans-[Ru(II)(DBQ)(NO(•))(PPh3)2Cl] and trans-[Ru(I)(DBQ)(NO(+))(PPh3)2Cl] states. PMID:25602939

  20. High-resolution EUS in children with eosinophilic “allergic” esophagitis

    Microsoft Academic Search

    Victor L. Fox; Samuel Nurko; Jonathan E. Teitelbaum; Kamran Badizadegan; Glenn T. Furuta

    2003-01-01

    Background: The pathophysiology of dysphagia associated with eosinophilic esophagitis is unknown. This study investigated possible anatomic alterations in children with eosinophilic esophagitis in comparison with healthy children by using high-resolution EUS to precisely measure individual tissue layers of the esophagus. Methods: Children with eosinophilic esophagitis (n = 11) and control children (n = 8) without esophagitis were prospectively evaluated by

  1. Esophagitis: old histologic concepts and new thoughts.

    PubMed

    Grin, Andrea; Streutker, Catherine J

    2015-06-01

    Context .- Inflammatory lesions of the esophagus are a diverse group, often with nonspecific histologic findings. These benign changes can produce diagnostic difficulties for pathologists. Objective .- To discuss the typical histologic findings of a variety of the most common causes of esophagitis (reflux, eosinophilic esophagitis, infections, medications) along with less common issues such as sloughing esophagitis and skin disorders involving the squamous mucosa. Data Sources .- The literature has been reviewed to discuss histologic definitions of current and developing issues in the area of esophagitis. Conclusions .- Histologic features are not entirely sensitive and specific for inflammatory esophageal disorders. Awareness of these problems is essential; clinical and endoscopic information can be very useful in distinguishing among the various lesions. PMID:26030241

  2. The Use of in vivo Real-Time Optical Imaging for Esophageal Neoplasia

    PubMed Central

    Vila, Peter M.; Thekkek, Nadhi; Richards-Kortum, Rebecca; Anandasabapathy, Sharmila

    2012-01-01

    Esophageal adenocarcinoma carries a poor prognosis, as it typically presents at a late stage. Thus, a major research priority is the development of novel diagnostic imaging strategies that can detect neoplastic lesions earlier and more accurately than current techniques. Advances in optical imaging allow clinicians to obtain real-time histopathologic information with instant visualization of cellular architecture and the potential to identify neoplastic tissue. The various endoscopic imaging modalities for esophageal neoplasia can be grouped into two major categories: (a) wide-field imaging, a comparatively lower-resolution view for imaging larger surface areas, and (b) high-resolution imaging, which allows individual cells to be visualized. This review will provide an overview of the various forms of real-time optical imaging in the diagnosis and management of Barrett's esophagus and esophageal adenocarcinoma. PMID:22069213

  3. Ataxia-telangiectasia mutated expression is associated with tobacco smoke exposure in esophageal cancer tissues and benzo[a]pyrene diol epoxide in cell lines.

    PubMed

    Jiang, Yan; Liang, Zheng D; Wu, Tsung T; Cao, Liyu; Zhang, Hongfu; Xu, Xiao-Chun

    2007-01-01

    Esophageal cancer is a substantial health problem because of its usually late stage at diagnosis and poor prognosis. Tobacco smoking and alcohol use are the most important risk factors in the development of esophageal squamous cell carcinoma (SCC). Our previous study demonstrated the binding of benzo[a]pyrene diol epoxide (BPDE), a carcinogen present in tobacco smoke and environmental pollution, to the ataxia-telangiectasia mutated (ATM) gene. To understand how this binding affects the alteration of ATM expression and to identify biomarkers for the detection of esophageal cancer, we analyzed ATM mRNA expression in tissue specimens from patients with esophageal SCC and premalignant lesions using in situ hybridization. We then performed in vitro experiments to verify and extend our ex vivo observations. We found that ATM expression was increased in esophageal SCC and its premalignant lesions when compared with normal tissues and that increased ATM expression was associated with tobacco smoke exposure and tumor de-differentiation. Moreover, BPDE induced ATM expression in esophageal SCC cell lines in a time-dependent manner. In summary, the BPDE in tobacco smoke may be responsible for increased ATM expression in premalignant and malignant esophageal tissues. Our findings suggest that the ATM gene should be further evaluated as a biomarker for the early detection of esophageal cancer and tobacco use in patients. PMID:17019709

  4. Esophagitis: Incidence and Risk of Esophageal Adenocarcinoma—A Population-Based Cohort Study

    Microsoft Academic Search

    Annmarie Lassen; Jesper Hallas; Ove B Schaffalitzky de Muckadell

    2006-01-01

    OBJECTIVES:Although symptoms of reflux are common, our knowledge of the epidemiology and natural history of gastroesophageal reflux disease is sparse. The risk of esophageal adenocarcinoma is increased among patients with acid reflux, but the contribution of Barrett's lesions is unknown.METHODS:With the aim to estimate the incidence of diagnosed endoscopic esophagitis lesions and the risk of esophageal adenocarcinoma among patients with

  5. Gastro-esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients

    Microsoft Academic Search

    M. Suter; G. Dorta; V. Giusti; J. M. Calmes

    2004-01-01

    Background: Morbid obesity has long been considered as a contributing factor to gastro-esophageal reflux, but the literature\\u000a contains conflicting data on the subject. The authors studied a large number of morbidly obese candidates for bariatric surgery\\u000a with objective means, in order to better define the incidence of gastro-esophageal reflux disease (GERD) and esophageal motility\\u000a disorders in this population. Methods: Morbidly

  6. Esophageal motility abnormalities in gastroesophageal reflux disease

    PubMed Central

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

    2014-01-01

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted. PMID:24868489

  7. Discovery of the new slowly pulsating B star HD 163830 (B5II/III) from MOST spacebased photometry

    E-print Network

    C. Aerts; P. De Cat; R. Kuschnig; J. M. Matthews; D. B. Guenther; A. F. J. Moffat; S. M. Rucinski; D. Sasselov; G. A. H. Walker; W. W. Weiss

    2006-04-03

    We report the discovery of a new slowly pulsating B (SPB) star, with the largest number of detected frequencies to date by more than a factor of three, based on 37 days of MOST (Microvariability & Oscillations of STars) satellite guide star photometry. The star HD 163830 (V = 9.3, B5II/III) varies in twenty detected frequencies in the range $0.035 - 1.06$ d$^{-1}$ ($0.4 - 12.3 ~ \\mu$Hz) with amplitudes from 0.7 to 7.6 mmag ($S/N$ from {4 to 43}). Eighteen of these frequencies are consistent with low-degree, high-order nonradial g-modes {of seismic models of an evolved 4.5$M_{\\odot}$ star. We are unable to identify one unique model due to lack of mode identifications. The lowest two frequencies may be associated with the rotation of HD 163830, but firm proof of this must await future spectroscopic data.

  8. Charge transport in micas: The kinetics of FeII/III electron transfer in the octahedral sheet

    SciTech Connect

    Rosso, Kevin M.; Ilton, Eugene S.

    2003-11-01

    The two principal FeII/III electron exchange reactions underlying charge transport in the octahedral sheet of ideal end-member annite were modeled using a combination of ab initio calculations and Marcus electron transfer theory. A small polaron model was applied which yielded electron hopping activation energies that agree well with the limited available experimental data. A small ab initio cluster model successfully reproduced several important structural, energetic, and magnetic characteristics of the M1 and M2 Fe sites in the annite octahedral sheet. The cluster enabled calculation of the internal reorganization energy and electronic coupling matrix elements for the M2-M2 and M1-M2 electron transfer reactions. The M2-M2 electron transfer is symmetric with a predicted forward/reverse electron hopping rate of 106 s-1. The M1-M2 electron transfers are asymmetric due to the higher ionization potential by 0.46 eV of FeII in the M1 site. The electronic coupling matrix elements for these reactions are predicted to be small and of similar magnitude, suggesting the possibility that the coupling is essentially direction independent amongst hopping directions in the octahedral sheet. M1 Fe sites are predicted to be efficient electron traps and charge transport should occur by nearest-neighbor electron hops along the M2 Fe sublattice.

  9. Apolipophorin II/I, apolipoprotein B, vitellogenin, and microsomal triglyceride transfer protein genes are derived from a common ancestor.

    PubMed

    Babin, P J; Bogerd, J; Kooiman, F P; Van Marrewijk, W J; Van der Horst, D J

    1999-07-01

    Large lipid transfer proteins (LLTP) are nonexchangeable apolipoproteins and intracellular lipid-exchange proteins involved in the assembly, secretion, and metabolism of lipoproteins. We have identified contiguous conserved sequence motifs in alignments of insect apolipophorin II/I precursor (apoLp-II/I), human apolipoprotein B (apoB), invertebrate and vertebrate vitellogenins (VTG), and the large subunit of mammalian microsomal triglyceride transfer protein (MTP). Conserved motifs present in the N-terminal part of nonexchangeable apolipoproteins encompass almost completely the large subunit of MTP, suggesting a derivation from a common ancestral functional unit, termed large lipid transfer (LLT) module. Divergence of LLTP from a common ancestor is supported by (1) the statistical significance of the combined match scores obtained after motif-based database searches, (2) the presence of several identical amino acid residues in all LLTP sequences currently available, (3) the conservation of hydrophobic clusters in an alpha-helical domain, (4) the phylogenetic analysis of the conserved sequences related to the von Willebrand factor D (VWD) module identified in nonexchangeable apolipoproteins, and (5) the presence of four and one ancestral exon boundaries in the LLT and VWD modules, respectively. Our data indicate that the genes coding for apoLp-II/I, apoB, VTG, and the MTP large subunit are members of the same multigene superfamily. LLTP have emerged from an ancestral molecule designed to ensure a pivotal event in the intracellular and extracellular transfer of lipids and liposoluble substances. PMID:10368443

  10. Molecular characterization and gene expression in the eye of the apolipophorin II/I precursor from Locusta migratoria.

    PubMed

    Bogerd, J; Babin, P J; Kooiman, F P; André, M; Ballagny, C; van Marrewijk, W J; van der Horst, D J

    2000-11-27

    The transport of lipids via the circulatory system of animals constitutes a vital function that uses highly specialized lipoprotein complexes. In insects, a single lipoprotein, lipophorin, serves as a reusable shuttle for the transport of lipids between tissues. We have found that the two nonexchangeable apolipoproteins of lipophorin arise from a common precursor protein, apolipophorin II/I (apoLp-II/I). To examine the mechanisms of transport of lipids and liposoluble substances inside the central nervous system, this report provides the molecular cloning of a cDNA encoding the locust apoLp-II/I. We have recently shown that this precursor protein belongs to a superfamily of large lipid transfer proteins (Babin et al. [1999] J. Mol. Evol. 49:150-160). We determined that, in addition to its expression in the fat body, the locust apoLp-II/I is also expressed in the brain. Part of the signal resulted from fat body tissue associated with the brain; however, apoLp-II/I was strongly expressed and the corresponding protein detected, in pigmented glial cells of the lamina underlying the locust retina and in cells or cellular processes interspersed in the basement membrane. The latter finding strongly suggests an implication of apolipophorins in the transport of retinoids and/or fatty acids to the insect retina. PMID:11056463

  11. Overexpression of long non-coding RNA UCA1 predicts a poor prognosis in patients with esophageal squamous cell carcinoma

    PubMed Central

    Li, Ji-Yuan; Ma, Xin; Zhang, Can-Bin

    2014-01-01

    Introduction: Long non-coding RNAs (lncRNAs) have been shown to have important regulatory roles in cancer biology, and the lncRNA UCA1 is upregulated in several cancers such as bladder cancer, breast cancer and colorectal cancer, however, the contributions of UCA1 to esophageal cancer remain largely unknown. Methods: Expression levels of lncRNA UCA1 in esophageal squamous cell carcinoma (ESCC) patients and esophageal cancer cell lines were evaluated by quantitative real-time PCR (qRT-PCR), and its association with overall survival of patients was analyzed by statistical analysis. Small interfering RNA was used to suppress UCA1 expression in esophageal cancer cell line. In vitro assays were conducted to further explore its underlying roles in tumor progression. Results: The relative level of UCA1 was significantly higher in ESCC tissues compared to the adjacent non-tumor tissues, and remarkably higher expression of UCA1 was found in esophageal cancer cell lines compared with the immortalized esophageal epithelial cell line NE1. The ESCC patients with higher UCA1 expression had an advanced clinical stage and a poorer prognosis than those with lower expression. In vitro assays, our data indicated that downregulation of UCA1 decrease cell proliferation, migration, and invasion ability. Conclusions: lncRNA UCA1 might be considered as a novel molecule involved in ESCC progression, which provides a potential prognostic biomarker and therapeutic target. PMID:25550835

  12. Severe Ulcerative Esophagitis Induced by Crizotinib Therapy

    PubMed Central

    Craig, Jamie; Bajaj, Rajesh; Spurling, Timothy

    2014-01-01

    Crizotinib is an oral tyrosine-kinase inhibitor that inhibits anaplastic lymphoma kinase (ALK) in gene-rearranged non-small cell lung cancer (NSCLC). In 2011, the Food and Drug Administration approved crizotinib for treatment of locally advanced or metastatic ALK-positive NSCLC. The crizotinib adverse events profile included esophageal disorders in 11% of patients treated during trial phases I, II, and III, but none of them had severe events. We describe the development of severe ulcerative esophagitis secondary to crizotinib therapy and the re-introduction of therapy at a lower dose without recurrence of esophageal symptoms.

  13. Resection of esophageal carcinoma during pregnancy.

    PubMed

    ?ahin, Murat; Kocaman, Gökhan; Özkan, Murat; Yüksel, Cabir; Enön, Serkan; Kutlay, Hakan

    2015-01-01

    Esophageal carcinoma diagnosed during pregnancy is a rare occurrence. A 26-year-old pregnant patient was referred to our hospital with dysphagia. A thorough examination showed a tumor in the esophagus. Laparotomy, thoracotomy, and cervical exploration were performed. There are only 2 cases reported in the literature about esophageal carcinoma diagnosed during pregnancy and treated surgically. However, ethical dilemmas arise in managing such situations. Here we report a case of esophageal squamous cell carcinoma diagnosed at 27 weeks of gestation in which surgical resection was performed successfully. PMID:25555961

  14. Esophageal melanocytosis in oral opium consumption.

    PubMed

    Geramizadeh, Bita; Asadian, Fatemeh; Taghavi, Alireza

    2014-01-01

    Esophageal melanocytosis is a rare and benign condition, characterized by melanocytic proliferation of the esophageal squamous epithelium with heavy melanin deposition. The etiology and pathogenesis has not been exactly known but it seems to be a chronic stimulus such as gastroesophageal reflux. This condition is very rare and about 35 cases have been reported so far, most of which have been from India and Japan. Herein, we present a case of esophageal melanocytosis in a patient with long history of oral opium consumption. To the best of our knowledge, such a history has not been reported. PMID:24719715

  15. Medical management of esophageal reflux.

    PubMed Central

    Hirschowitz, B. I.

    1994-01-01

    Gastroesophageal reflux of varying severity is a common disorder for which medical attention is sought at all levels, from pharmacists to specialist physicians and surgeons. This brief overview represents my current understanding of reflux, its effects on the esophagus and my personal approach to treatment of these disorders. Of necessity, because the literature is so extensive (a Medline search on reflux from 1966 to 1993 yielded over 1500 papers.), I have relied in places on the extensive review by Marks and Richter [1]. My paper emphasizes the evaluation and treatment of patients with symptomatic reflux, esophagitis and its complications. It describes why it is important to grade the disorders so that the treatment used is appropriate to the severity of the disease. The more severe the disease, the more specific the diagnostic information needed and the more exacting the treatment. Various treatments and outcomes of therapy are discussed, and a role for surgery is defined. The essence of effective medical treatment of esophagitis is to reduce acidity of the refluxate to a level outside the optimum proteolytic pH range of pepsin, i.e. greater than pH 3.5. PMID:7502531

  16. Esophageal papilloma: Flexible endoscopic ablation by radiofrequency.

    PubMed

    Del Genio, Gianmattia; Del Genio, Federica; Schettino, Pietro; Limongelli, Paolo; Tolone, Salvatore; Brusciano, Luigi; Avellino, Manuela; Vitiello, Chiara; Docimo, Giovanni; Pezzullo, Angelo; Docimo, Ludovico

    2015-03-16

    Squamous papilloma of the esophagus is a rare benign lesion of the esophagus. Radiofrequency ablation is an established endoscopic technique for the eradication of Barrett esophagus. No cases of endoscopic ablation of esophageal papilloma by radiofrequency ablation (RFA) have been reported. We report a case of esophageal papilloma successfully treated with a single session of radiofrequency ablation. Endoscopic ablation of the lesion was achieved by radiofrequency using a new catheter inserted through the working channel of endoscope. The esophageal ablated tissue was removed by a specifically designed cup. Complete ablation was confirmed at 3 mo by endoscopy with biopsies. This case supports feasibility and safety of as a new potential indication for Barrx(TM) RFA in patients with esophageal papilloma. PMID:25789102

  17. Eosinophilic Esophagitis (EE) or (EoE)

    MedlinePLUS

    ... These include asthma, allergic rhinitis, atopic dermatitis and food allergy. EoE has also been shown to occur in ... often part of the EoE evaluation. Eosinophilic Esophagitis: Food Allergies Adverse immune responses to food are the main ...

  18. Cervical esophageal hemangioma combined with thyroid cancer.

    PubMed

    Lee, Jong Cheol; Kim, Jeong Won; Lee, Yong Jik; Lee, Seong Rok; Park, Chang-Ryul; Jung, Jong-Pil

    2011-08-01

    Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision. PMID:22263178

  19. Effect of total laryngectomy on esophageal motility

    SciTech Connect

    Hanks, J.B.; Fisher, S.R.; Meyers, W.C.; Christian, K.C.; Postlethwait, R.W.; Jones, R.S.

    1981-01-01

    Total laryngectomy for cancer can result in dysphagia and altered esophageal motility. Manometric changes in the upper esophageal sphincter (UES), and in proximal and distal esophageal function have been reported. However, most studies have failed to take into account radiation therapy and appropriate controls. We selected ten male patients (54.3 +/- 1.9 yr) for longitudinal manometric evaluation prior to laryngectomy then at two weeks and again six months later. No patient received preoperative radiation therapy, had a previous history of esophageal surgery, or developed a postoperative wound infection or fistula. Seven of ten patients had positive nodes and received 6,000-6,600 rads postoperative radiation therapy. Preoperatively 4 of 10 patients complained of dysphagia which did not significantly change following surgery and radiation. Two of three patients who did not complain of dysphagia preoperatively and received radiation postoperatively developed dysphagia. No patient without dysphagia preoperatively who received no radiation therapy developed symptoms. Our studies show that laryngectomy causes alterations in the UES resting and peak pressures but not in the proximal or distal esophagus, or the lower esophageal sphincter. These data also imply radiation therapy may be associated with progressive alterations in motility and symptomatology. Further study regarding the effects of radiation on esophageal motility and function are urged.

  20. A novel intermediate mucolipidosis II/III?? caused by GNPTAB mutation in the cytosolic N-terminal domain

    PubMed Central

    Leroy, Jules G; Sillence, David; Wood, Tim; Barnes, Jarrod; Lebel, Robert Roger; Friez, Michael J; Stevenson, Roger E; Steet, Richard; Cathey, Sara S

    2014-01-01

    Mucolipidosis (ML) II and ML III?/? are allelic autosomal recessive metabolic disorders due to mutations in GNPTAB. The gene encodes the enzyme UDP-GlcNAc-1-phosphotransferase (GNPT), which is critical to proper trafficking of lysosomal acid hydrolases. The ML phenotypic spectrum is dichotomous. Criteria set for defining ML II and ML III?/? are inclusive for all but the few patients with phenotypes that span the archetypes. Clinical and biochemical findings of the ‘intermediate' ML in eight patients with the c.10A>C missense mutation in GNPTAB are presented to define this intermediate ML and provide a broader insight into ML pathogenesis. Extensive clinical information, including radiographic examinations at various ages, was obtained from a detailed study of all patients. GNPTAB was sequenced in probands and parents. GNPT activity was measured and cathepsin D sorting assays were performed in fibroblasts. Intermediate ML patients who share the c.10A>C/p.K4Q mutation in GNPTAB demonstrate a distinct, consistent phenotype similar to ML II in physical and radiographic features and to ML III?/? in psychomotor development and life expectancy. GNPT activity is reduced to 7–12% but the majority of newly synthesized cathepsin D remains intracellular. The GNPTAB c.10A>C/p.K4Q missense allele results in an intermediate ML II/III with distinct clinical and biochemical characteristics. This delineation strengthens the utility of the discontinuous genotype–phenotype correlation in ML II and ML III?/? and prompts additional studies on the tissue-specific pathogenesis in GNPT-deficient ML. PMID:24045841

  1. Management of refractory Eosinophilic Esophagitis

    PubMed Central

    Mukkada, Vincent A.; Furuta, Glenn T.

    2014-01-01

    Background/Aims Whereas most children and adults respond to traditional EoE treatments, such as exclusion of dietary allergens or the use of topical steroids, a small fraction may not. Methods Based on clinical experiences and review of the literature, the aim of this work is to provide practical advice to care for ‘refractory’ patients with EoE. Results The approach to this type of patient continues to evolve and decision-making should consider a number of issues including the patient's age, lack of complete understanding of the natural history of this disease, risks of monitoring and side effects of treatments. Next, one needs to define the term refractory, in that this can refer either to persistent symptoms, or to continued inflammation in the face of presumably effective drug or diet therapy. Before considering alternative treatments, it is important to rule out any other cause of persistent symptoms. For instance, could they be related to an occult esophageal narrowing not identified at the time of endoscopy? Esophagrams may be necessary to identify localized or longitudinal narrowing that could be amenable to dilation. If symptoms and inflammation are persistent and no narrowing is appreciated, an elemental diet can be considered but the long term use of this in older children and adults may be difficult. Prednisone or systemic steroids may be indicated to induce remission but side effects and complications associated with chronic use are limiting. Finally, the use of immunosuppression or biological agents has been reported in case reports and studies; use of these may be limited by side effects or the need to utilize compassionate use protocols. Conclusions As the scope of esophageal eosinophilia continues to evolve, the clinical and molecular characterization of new clinical phenotypes will be important so that new therapeutic targets can be identified. PMID:24603397

  2. Structures of withanosides I, II, III, IV, V, VI, and VII, new withanolide glycosides, from the roots of Indian Withania somnifera D unal. and inhibitory activity for tachyphylaxis to clonidine in isolated guinea-pig ileum

    Microsoft Academic Search

    Hisashi Matsuda; Toshiyuki Murakami; Akinobu Kishi; Masayuki Yoshikawa

    2001-01-01

    Seven new withanolide glycosides called withanosides I, II, III, IV, V, VI, and VII were isolated from an Indian natural medicine, Ashwagandha, the roots of Indian Withania somniferaDunal. (Solanaceae), together with four known compounds, withaferin A, 5?,20?F(R)-dihydroxy-6?,7?-epoxy-1-oxowitha-2,24-dienolide, physagulin D, and coagulin Q. The structures of withanosides I, II, III, IV, V, VI, and VII were determined based on chemical and

  3. Treatment outcomes of neoadjuvant concurrent chemoradiotherapy followed by esophagectomy for patients with esophageal cancer

    PubMed Central

    Kim, Yong-Hyub; Song, Sang-Yun; Shim, Hyun-Jeong; Chung, Woong-Ki; Ahn, Sung-Ja; Yoon, Mee Sun; Jeong, Jae-Uk; Song, Ju-Young

    2015-01-01

    Purpose To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT). Materials and Methods We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%). Results The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient. Conclusion Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT. PMID:25874173

  4. Successful treatment of esophageal cancer with transhiatal esophagectomy after heart transplantation

    Microsoft Academic Search

    Dipin Gupta; Mahender Macha; Valentino Piacentino; Arun K Singhal; Harvey F Sasken; Satoshi Furukawa; Daniel T Dempsey

    2004-01-01

    A 55-year-old heart transplant recipient with reflux esophagitis presented for routine endoscopic surveillance of an area of Barrett's metaplasia initially seen 3 years previously. Esophagogastroduodenoscopy revealed adenocarcinoma at 33 cm from the incisors. The preoperative clinical stage was T1N0M0 by endoscopic ultrasound. Transhiatal esophagectomy was performed with R0 resection of the cancer, and the patient recovered uneventfully. Pathologic examination confirmed

  5. Esophageal cancer as second primary tumor after breast cancer radiotherapy

    Microsoft Academic Search

    Beatrix Scholl; Ernane D Reis; Abderrahim Zouhair; Igor Chereshnev; Jean-Claude Givel; Michel Gillet

    2001-01-01

    Background: An increased risk of esophageal cancer has been reported in survivors of breast cancer treated with radiotherapy. This study further characterizes this association.Methods: Through hospital databases, 118 patients (109 men, 9 women) treated for esophageal cancer between 1985 and 1993 were identified, of whom 37 had 60 synchronous or metachronous cancers. 5 women had primary esophageal cancer after having

  6. Molecular and cellular features of esophageal cancer cells

    Microsoft Academic Search

    Tetsuro Nishihira; Yu Hashimoto; Masafumi Katayama; Shozo Mori; Toshio Kuroki

    1993-01-01

    More than 70 cell lines were established from esophageal cancer, including 15 TE-series cell lines established by the authors. This article reviews molecular and cellular features of esophageal cancer cells from studies using these cell lines as well as primary tumors. The subjects reviewed include primary cultures of normal epithelium of the esophagus and of esophageal tumors, their growth and

  7. Relationship among esophageal dysfunction, diabetic gastroenteropathy, and peripheral neuropathy

    Microsoft Academic Search

    C. O. H. Russell; R. Gannan; J. Coatsworth; R. Neilsen; F. Allen; L. D. Hill; C. E. Pope

    1983-01-01

    Esophageal motor function was tested in 12 patients with a clinical diagnosis of diabetic gastroenteropathy by radionuclide transit (RT) studies. Other insulin-dependent diabetics with and without symptoms of peripheral neuropathy but with no symptoms of gastrointestinal disease were similarly studied. Eleven of the 12 patients with gastroenteropathy were found to have abnormal esophageal function, even though only five had esophageal

  8. Case Report Alendronate-induced Esophagitis in an Elderly Woman

    Microsoft Academic Search

    Victoria Gómez; Shu-Yuan Xiao

    Ingestion of alendronate sodium (Fosamax) had been reported to sometimes cause erosive or ulcerative esophagitis. Despite its widespread use and several case reports describing the clinical and endoscopic presentation, there has been limited discussion on the histologic appearances of the esophagitis caused by the medication. Here we describe one case of an elderly woman who presented with alendronate-induced esophagitis. The

  9. Comparative Genomic Hybridization of Esophageal Squamous Cell Carcinoma

    E-print Network

    Lin, Chi-Hung

    Comparative Genomic Hybridization of Esophageal Squamous Cell Carcinoma Correlations between aberrations of 46 samples of esophageal squamous cell carcinoma (EC-SCC) were analyzed by comparative genomic of the Department of Health, Taiwan, Re- public of China), and esophageal squamous cell carcinoma (EC

  10. Conservative surgical treatment of reflux esophagitis and esophageal stricture.

    PubMed Central

    Herrington, J L; Wright, R S; Edwards, W H; Sawyers, J L

    1975-01-01

    During a recent 3-year period, 17 consecutive patients were seen with advanced fibrotic esophageal strictures secondary to alkaline-acid-pepsin reflux. From detailed preoperative evaluations alone it was impossible to determine whether therapy should consist of excisional surgery, esophagogastroplasty or intra-operative dilatation with correction of reflux. Only at operation could the length, extent, degree and severity of the stricture be fully determined. Each of the 17 patients was treated by controlled dilatation, coupled with an antireflux procedure. This simplified approach proved successful on strictures thought preoperatively to be undilatable. It appears that this conservative approach is applicable to many advanced strictures and excisional and plastic procedures should be reserved for those cases that prove unyielding to intraoperative dilatation. The true appraisal of a reflux stricture and the choice of surgical procedure is best determined at the operating table. Images Fig. 5A. Fig. 5B. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. Fig. 12. Fig. 13. Fig. 14. Fig. 15. Fig. 16. Fig. 17. Fig. 18. Fig. 19. Fig. 20. Fig. 21. PMID:1130874

  11. Assembly and properties of heterobimetallic Co(II/III)/Ca(II) complexes with aquo and hydroxo ligands.

    PubMed

    Lacy, David C; Park, Young Jun; Ziller, Joseph W; Yano, Junko; Borovik, A S

    2012-10-24

    The use of water as a reagent in redox-driven reactions is advantageous because it is abundant and environmentally compatible. The conversion of water to dioxygen in photosynthesis illustrates one example, in which a redox-inactive Ca(II) ion and four manganese ions are required for function. In this report we describe the stepwise formation of two new heterobimetallic complexes containing Co(II/III) and Ca(II) ions and either hydroxo or aquo ligands. The preparation of a four-coordinate Co(II) synthon was achieved with the tripodal ligand, N,N',N"-[2,2',2"-nitrilotris(ethane-2,1-diyl)]tris(2,4,6-trimethylbenzenesulfonamido, [MST](3-). Water binds to [Co(II)MST](-) to form the five-coordinate [Co(II)MST(OH(2))](-) complex that was used to prepare the Co(II)/Ca(II) complex [Co(II)MST(?-OH(2))Ca(II)?15-crown-5(OH(2))](+) ([Co(II)(?-OH(2))Ca(II)OH(2)](+)). [Co(II)(?-OH(2))CaOH(2)](+) contained two aquo ligands, one bonded to the Ca(II) ion and one bridging between the two metal ions, and thus represents an unusual example of a heterobimetallic complex containing two aquo ligands spanning different metal ions. Both aquo ligands formed intramolecular hydrogen bonds with the [MST](3-) ligand. [Co(II)MST(OH(2))](-) was oxidized to form [Co(III)MST(OH(2))] that was further converted to [Co(III)MST(?-OH)Ca(II)?15-crown-5](+) ([Co(III)(?-OH)Ca(II)](+)) in the presence of base and Ca(II)OTf(2)/15-crown-5. [Co(III)(?-OH)Ca(II)](+) was also synthesized from the oxidation of [Co(II)MST](-) with iodosylbenzene (PhIO) in the presence of Ca(II)OTf(2)/15-crown-5. Allowing [Co(III)(?-OH)Ca(II)](+) to react with diphenylhydrazine afforded [Co(II)(?-OH(2))Ca(II)OH(2)](+) and azobenzene. Additionally, the characterization of [Co(III)(?-OH)Ca(II)](+) provides another formulation for the previously reported Co(IV)-oxo complex, [(TMG(3)tren)Co(IV)(?-O)Sc(III)(OTf)(3)](2+) to one that instead could contain a Co(III)-OH unit. PMID:22998407

  12. Assembly and Properties of Heterobimetallic CoII/III/CaII Complexes with Aquo and Hydroxo Ligands

    PubMed Central

    Lacy, David C.; Park, Young Jun; Ziller, Joseph W.; Yano, Junko; Borovik, A. S.

    2012-01-01

    The use of water as a reagent in redox-driven reactions is advantageous because it is abundant and environmentally compatible. The conversion of water to dioxygen in photosynthesis illustrates one example, in which a redox-inactive CaII ion and four manganese ions are required for function. In this report we describe the stepwise formation of two new heterobimetallic complexes containing CoII/III and CaII ions, and either hydroxo or aquo ligands. The preparation of a 4-coordinate CoII synthon was achieved with the tripodal ligand, N,N?,N?-[2,2?,2?-nitrilotris(ethane-2,1-diyl)]tris(2,4,6-trimethylbenzenesulfonamido, [MST]3?. Water binds to [CoIIMST]? to form the 5-coordinate [CoIIMST(OH2)]? complex that was used to prepare the CoII/CaII complex [CoIIMST(?-OH2)CaII?15-crown-5(OH2)]+ ([CoII(?-OH2)CaIIOH2]+). [CoII(?-OH2)CaOH2]+ contained two aquo ligands, one bonded to the CaII ion and one bridging between the two metal ions and thus represents an unusual example of a heterobimetallic complex containing 2 aquo ligands spanning different metal ions. Both aquo ligands formed intramolecular hydrogen bonds with the [MST]3? ligand. [CoIIMST(OH2)]? was oxidized to form [CoIIIMST(OH2)] that was further converted to [CoIIIMST(?-OH)CaII?15-crown-5]+ ([CoIII(?-OH)CaII]+) in the presence of base and CaIIOTf2/15-crown-5. [CoIII(?-OH)CaII]+ was also synthesized from the oxidation of [CoIIMST]? with PhIO in the presence of CaIIOTf2/15-crown-5. Allowing [CoIII(?-OH)CaII]+ to react with diphenylhydrazine afforded [CoII(?-OH2)CaIIOH2]+ and azobenzene. Additionally, the characterization of [CoIII(?-OH)CaII]+ provides another formulation for the previously reported CoIV–oxo complex, [(TMG3tren)CoIV(?-O)ScIII(OTf)3]2+ to one that instead could contain a CoIII–OH unit. PMID:22998407

  13. Eosinophilic esophagitis -- clinical manifestations, diagnosis, and treatment.

    PubMed

    Lucendo Villarín, A J

    2009-01-01

    Eosinophilic esophagitis (EE) is a chronic inflammatory, immunoallergic disease of the esophagus that represents the most common eosinophilic gut disease. Understanding and diagnosis regarding this condition have greatly increased in recent years, particularly in Europe and North America, in parallel with other allergic disorders. It consists of dense esophageal infiltration with eosinophils in the absence of gastro-esophageal reflux (GER). It involves individuals at all ages, and is particularly common in males during childhood and up to the 5th decade of life. It manifests with chronic, intermittent esophageal symptoms that predominantly include dysphagia, food impaction episodes, and GER-attributable complaints that do not respond to antisecretory therapy. Endoscopically, EE is a polymorphous disease that presents with various changes in esophageal caliber, and subtle changes in mucosal appearance, which lead to biopsy collection as a key procedure for diagnosis. Management must be multidisciplinary, including gastroenterologists, pathologists, allergologists, and also nutrition specialists in pediatric cases. Regarding therapy, dietary food restrictions are especially useful in the management of pediatric EE, but effectiveness is lower in the adult, maybe because of a greater involvement of air allergens. Drug use is standard, particularly involving topical steroids, which may revert manifestations and histological lesions, even though recurrence following discontinuation is common. PMID:19335033

  14. Microbiome in Reflux Disorders and Esophageal Adenocarcinoma

    PubMed Central

    Yang, Liying; Chaudhary, Noami; Baghdadi, Jonathan; Pei, Zhiheng

    2014-01-01

    The incidence of esophageal adenocarcinoma has increased dramatically in the United States and Europe since the 1970s without apparent cause. Although specific host factors can affect risk of disease, such a rapid increase in incidence must be predominantly environmental. In the stomach, infection with Helicobacter pylori has been linked to chronic atrophic gastritis, an inflammatory precursor of gastric adenocarcinoma. However, the role of H. pylori in the development of esophageal adenocarcinoma is not well established. Meanwhile, several studies have established that a complex microbiome in the distal esophagus might play a more direct role. Transformation of the microbiome in precursor states to esophageal adenocarcinoma—reflux esophagitis and Barrett’s metaplasia—from a predominance of gram-positive bacteria to mostly gram-negative bacteria raises the possibility that dysbiosis is contributing to pathogenesis. However, knowledge of the microbiome in esophageal adenocarcinoma itself is lacking. Microbiome studies open a new avenue to the understanding of the etiology and pathogenesis of reflux disorders. PMID:24855009

  15. Voluntary exercise partially reverses neonatal alcohol-induced deficits in mPFC layer II/III dendritic morphology of male adolescent rats.

    PubMed

    Hamilton, G F; Criss, K J; Klintsova, A Y

    2015-08-01

    Developmental alcohol exposure in humans can produce a wide range of deficits collectively referred to as fetal alcohol spectrum disorders (FASD). FASD-related impairments in executive functioning later in life suggest long-term damage to the prefrontal cortex (PFC). In rodent neonates, moderate to high levels of alcohol exposure decreased frontal lobe brain size and altered medial PFC pyramidal neuron dendritic morphology. Previous research in our lab demonstrated that neonatal alcohol exposure decreased basilar dendritic complexity but did not affect spine density in Layer II/III pyramidal neurons in 26- to 30-day-old rats. The current study adds to the literature by evaluating the effect of neonatal alcohol exposure on mPFC Layer II/III basilar dendritic morphology in adolescent male rats. Additionally, it examines the potential for voluntary exercise to mitigate alcohol-induced deficits on mPFC dendritic complexity. An animal model of binge drinking during the third trimester of pregnancy was used. Rats were intubated with alcohol (alcohol-exposed, AE; 5.25 g kg(-1 ) day(-1) ) on postnatal days (PD) 4-9; two control groups were included (suckle control and sham-intubated). Rats were anesthetized and perfused with heparinized saline solution on PD 42, and brains were processed for Golgi-Cox staining. Developmental alcohol exposure decreased spine density and dendritic complexity of basilar dendrites of Layer II/III neurons in the medial PFC (mPFC) compared to dendrites of control animals. Voluntary exercise increased spine density and dendritic length in AE animals resulting in elimination of the differences between AE and SH rats. Thus, voluntary exercise during early adolescence selectively rescued alcohol-induced morphological deficits in the mPFC. Synapse 69:405-415, 2015. © 2015 Wiley Periodicals, Inc. PMID:25967699

  16. Herpetic esophagitis in immunocompetent medical student.

    PubMed

    Marinho, Andréia Vidica; Bonfim, Vinícius Mendes; de Alencar, Luciana Rodrigues; Pinto, Sebastião Alves; de Araújo Filho, João Alves

    2014-01-01

    Esophagitis caused by herpes simplex virus (HSV) is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV); it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient. PMID:24707416

  17. An overview of esophageal squamous cell carcinoma proteomics.

    PubMed

    Qi, Yi-Jun; Chao, Wei-Xia; Chiu, Jen-Fu

    2012-06-18

    Esophageal squamous cell carcinoma (ESCC) still remains the leading cancer-caused mortality in northern China, in particular in areas nearby Taihang Mountain. Late-stage diagnosis of ESCC increases the mortality and morbidity of ESCC. Therefore, it is imperative to identify biomarkers for early diagnosis, monitoring of tumor progression and identifying potential therapeutic targets of ESCC. Proteomics provides a functional translation of the genome and represents a richer source for the functional description of diseases and biomarkers implicated in cancer. In this review, we discuss the dysregulated proteins associated with ESCC identified by proteomic approaches and aim to enhance our understanding of molecular mechanisms implicated in ESCC development and progression from a proteomics perspective and discuss the potential biomarkers of ESCC as well. PMID:22564818

  18. Advances in clinical management of eosinophilic esophagitis.

    PubMed

    Dellon, Evan S; Liacouras, Chris A

    2014-12-01

    Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated clinicopathologic condition that has become an increasingly important cause of upper gastrointestinal morbidity in adults and children over the past 2 decades. It is diagnosed based on symptoms of esophageal dysfunction, the presence of at least 15 eosinophils/high-power field in esophageal biopsy specimens, and exclusion of competing causes of esophageal eosinophilia, including proton pump inhibitor-responsive esophageal eosinophilia. We review what we have recently learned about the clinical aspects of EoE, discussing the clinical, endoscopic, and histological features of EoE in adults and children. We explain the current diagnostic criteria and challenges to diagnosis, including the role of gastroesophageal reflux disease and proton pump inhibitor-responsive esophageal eosinophilia. It is also important to consider the epidemiology of EoE (with a current incidence of 1 new case per 10,000 per year and prevalence of 0.5 to 1 case per 1000 per year) and disease progression. We review the main treatment approaches and new treatment options; EoE can be treated with topical corticosteroids, such as fluticasone and budesonide, or dietary strategies, such as amino acid-based formulas, allergy test-directed elimination diets, and nondirected empiric elimination diets. Endoscopic dilation has also become an important tool for treatment of fibrostenotic complications of EoE. There are a number of unresolved issues in EoE, including phenotypes, optimal treatment end points, the role of maintenance therapy, and treatment of refractory EoE. The care of patients with EoE and the study of the disease span many disciplines; EoE is ideally managed by a multidisciplinary team of gastroenterologists, allergists, pathologists, and dieticians. PMID:25109885

  19. False esophageal hiatus hernia caused by a foreign body: A fatal event

    PubMed Central

    Lu, Ya-Ping; Yao, Ming; Zhou, Xu-Yan; Huang, Bing; Qi, Wei-Bo; Chen, Zhi-Heng; Xu, Long-Sheng

    2014-01-01

    Foreign body ingestion is a common complaint in gastrointestinal clinics. It is usually not difficult to diagnose because most of the patients report a definitive history of accidental foreign body ingestion. However, in rare cases, patients do not have a clear history. Thus, the actual condition of the patient is difficult to diagnosis or is misdiagnosed; consequently, treatment is delayed or the wrong treatment is administered, respectively. This report describes a fatal case of esophageal perforation caused by an unknowingly ingested fishbone, which resulted in lower esophageal necrosis, chest cavity infection, posterior mediastinum fester, and significant upper gastrointestinal accumulation of blood. However, his clinical symptoms and imaging data are very similar with esophageal hiatal hernia. Unfortunately, because the patient was too late in consulting a physician, he finally died of chest infection and hemorrhage caused by thoracic aortic rupture. First, this case report underlines the importance of immediate consultation with a physician as soon as symptoms are experienced so as not to delay diagnosis and treatment, and thus avoid a fatal outcome. Second, diagnostic imaging should be performed in the early stage, without interference by clinical judgment. Third, when computed tomography reveals esophageal hiatus hernia with stomach incarceration, posterior mediastinal hematoma, and pneumatosis caused by esophageal, a foreign body should be suspected. Finally, medical professionals are responsible for making people aware of the danger of foreign body ingestion, especially among children, those who abuse alcohol, and those who wear dentures, particularly among the elderly, whose discriminability of foreign bodies is decreased, to avoid dire consequences. PMID:25339840

  20. False esophageal hiatus hernia caused by a foreign body: a fatal event.

    PubMed

    Lu, Ya-Ping; Yao, Ming; Zhou, Xu-Yan; Huang, Bing; Qi, Wei-Bo; Chen, Zhi-Heng; Xu, Long-Sheng

    2014-10-21

    Foreign body ingestion is a common complaint in gastrointestinal clinics. It is usually not difficult to diagnose because most of the patients report a definitive history of accidental foreign body ingestion. However, in rare cases, patients do not have a clear history. Thus, the actual condition of the patient is difficult to diagnosis or is misdiagnosed; consequently, treatment is delayed or the wrong treatment is administered, respectively. This report describes a fatal case of esophageal perforation caused by an unknowingly ingested fishbone, which resulted in lower esophageal necrosis, chest cavity infection, posterior mediastinum fester, and significant upper gastrointestinal accumulation of blood. However, his clinical symptoms and imaging data are very similar with esophageal hiatal hernia. Unfortunately, because the patient was too late in consulting a physician, he finally died of chest infection and hemorrhage caused by thoracic aortic rupture. First, this case report underlines the importance of immediate consultation with a physician as soon as symptoms are experienced so as not to delay diagnosis and treatment, and thus avoid a fatal outcome. Second, diagnostic imaging should be performed in the early stage, without interference by clinical judgment. Third, when computed tomography reveals esophageal hiatus hernia with stomach incarceration, posterior mediastinal hematoma, and pneumatosis caused by esophageal, a foreign body should be suspected. Finally, medical professionals are responsible for making people aware of the danger of foreign body ingestion, especially among children, those who abuse alcohol, and those who wear dentures, particularly among the elderly, whose discriminability of foreign bodies is decreased, to avoid dire consequences. PMID:25339840

  1. Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients

    Microsoft Academic Search

    Jeremy R Parfitt; James C Gregor; Neville G Suskin; Hani A Jawa; David K Driman

    2006-01-01

    Eosinophilic esophagitis in adults is a recently described entity occurring in young males with dysphagia, in whom esophageal biopsies show eosinophilic infiltration. This study defines the clinical and histological features of patients with eosinophilic esophagitis, distinguishing it from gastroesophageal reflux disease. Esophageal biopsies from patients with dysphagia or esophagitis were reviewed blindly, and assessed for: epithelial eosinophil counts, presence of

  2. Influence of Ionizing Radiation on Stromal-Epithelial Communication in Esophageal Carcinogenesis

    NASA Astrophysics Data System (ADS)

    Huff, Janice; Patel, Zarana; Grugan, Katharine; Rustgi, Anil; Cucinotta, Francis A.

    Esophageal cancer is the 6th leading cause of cancer death worldwide and is associated with a variety of risk factors including tobacco use, heavy alcohol consumption, human papilloma virus infection, and certain dietary factors such as trace mineral and vitamin deficiencies. A connection with ionizing radiation exposure is revealed by the high excess relative risk for esophageal squamous cell carcinoma observed in the survivors of the atomic bomb detonations in Japan. Esophageal carcinomas are also seen as secondary malignancies in patients who received radiotherapy for breast and thoracic cancers; additionally, patients with head/neck and oral squamous cell cancers are at increased risk for metachronous esophageal squamous cell cancers. This malignancy is rapidly fatal, mainly because it remains asymptomatic until late, advanced stages when the disease is rarely responsive to treatment. In normal epithelium, the stromal microenvironment is essential for the maintenance and modulation of cell growth and differentiation. Cross talk between the epithelial and stromal compartments can influence many aspects of malignant progression, including tumor cell proliferation, migration, invasion and recruitment of new blood vessels. To test the hypothesis that radiation exposure plays a role in esophageal carcinogenesis via non-targeted mechanisms involving stromal-epithelial cell communication, we are studying radiation effects on hTERT-immortalized human esophageal epithelial cells and genetic variants grown in co-culture with human esophageal stromal fibrob-lasts (Okawa et al., Genes Dev. 2007. 21: 2788-2803). We examined how irradiation of stromal fibroblasts affected epithelial migration and invasion, behaviors associated with cancer promotion and progression. These assays were conducted in modified Boyden chambers using conditioned media from irradiated fibroblasts. Our results using low LET gamma radiation showed a dose-dependent increase in migration of epithelial cells when exposed to conditioned media from irradiated vs. non-irradiated fibroblasts. We also observed enhanced invasion through a basement membrane matrix in similarly treated cells. Candidate factors that me-diate these effects were identified using antibody capture arrays, and their increased secretion in irradiated fibroblasts was confirmed using ELISAs. We are currently analyzing the effect of these individual factors on epithelial migration and invasion, as well as their influence on cell survival and DNA repair. Our current studies using high-LET radiation will elucidate radiation quality effects on these processes. These results should further our understanding of the mechanisms by which radiation impacts the tissue microenvironment and how it influences cancer development processes.

  3. Effects of epidural anesthesia and postoperative epidural analgesia on immune function in esophageal carcinoma patients undergoing thoracic surgery

    PubMed Central

    GU, CHENG-YONG; ZHANG, JIN; QIAN, YAN-NING; TANG, QI-FENG

    2015-01-01

    Thoracic epidural anesthesia (TEA) has been demonstrated to significantly reduce stress and immune dysfunction in trauma patients. In esophageal carcinoma patients undergoing thoracic surgery, TEA combined with general anesthesia during surgery and subsequent postoperative patient-controlled epidural analgesia (PCEA) may improve plasma cortisol (Cor), interleukin (IL)-6 and IL-17 levels and helper T-cell differentiation. A total of 60 esophageal carcinoma patients undergoing thoracic surgery were randomly allocated into groups I, II, III and I (n=15 per group). During surgery, groups I and II received total intravenous general anesthesia (TIVA), whereas groups III and IV received combined TEA and TIVA. Postoperatively, groups I and III received postoperative patient-controlled intravenous analgesia (PCIA), while groups II and IV received PCEA. The Cor, IL-6, IFN-?, IL-4 and IL-17 levels were measured in peripheral blood samples collected prior to anesthesia (T0), at 2 h after incision (T1), at 4 h postoperatively (T2), at 24 h postoperatively (T3) and at 48 h postoperatively (T4). The plasma Cor, IL-17 and IL-6 levels increased significantly at the beginning of the operation in groups I, II and III, while in group IV there were no significant differences during the entire period, concurrent with enhanced Th0 to Th2 shift, contributing to a Th2-dominant Th1/Th2 ratio. General anesthesia with TEA more efficiently inhibited the onset of the Th2-dominant status and decreased the plasma levels of Cor and IL-6 compared to general anesthesia alone and PCEA inhibited the Th2-dominant status more efficiently compared to PCIA. Therefore, general anesthesia combined with TEA and sole administration of PCEA were demonstrated to inhibit the stress response and minimize immune dysfunction, generating most pronounced results upon combination TEA/PCEA treatment. PMID:25469293

  4. Frequency of eosinophilic esophagitis in patients with esophageal symptoms: a single-center Turkish experience.

    PubMed

    Altun, R; Akbas, E; Y?ld?r?m, A E; Öcal, S; Korkmaz, M; Selcuk, H

    2013-01-01

    Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized with symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. There has been a dramatic increase in the diagnosis of this disease in recent years. The primary objective of this study was to determine the frequency of EoE in adult patients who were evaluated by gastroenterologists in our clinic with esophageal symptoms. Between November 2010 and May 2011, 311 adult patients who were evaluated in our clinic with esophageal symptoms were enrolled prospectively. All patients underwent endoscopy and had biopsies taken. Gastroesophageal reflux disease was excluded by either proton pump inhibitory treatment or 24-hour ambulatory pH monitorization. The diagnosis was confirmed by one independent pathologist. Frequency of EoE in patients with esophageal symptoms was 2.6% (n = 8; four men and four women). Mean age at diagnosis was 40.2 ± 8 years. Heartburn was the predominant symptom in patients (75% of the patients), and 87.5% (n = 7) of patients had more than one symptom at diagnosis. Nearly 38% of the patients (n = 3) had a history of allergic disease. Endoscopic findings were as follows: transient/fixed esophageal rings (25%), white exudates (25%), and normal appearance (50%). Median number of circulating eosinophils was 208 (93-659)/mm(3) . Median number of intraepithelial eosinophils in proximal-middle 1/3 part and distal 1/3 part of esophagus were 0 (0-50)/hpf and 37 (16-50)/hpf, respectively. In conclusion, EoE is not rare in Turkey, and it should be considered in the differential diagnosis of patients with esophageal symptoms. PMID:22925366

  5. IgG4-Related Esophageal Disease Presenting as Esophagitis Dissecans Superficialis With Chronic Strictures.

    PubMed

    Dumas-Campagna, Myriam; Bouchard, Simon; Soucy, Genevieve; Bouin, Mickael

    2014-08-01

    IgG4-related disease is a recently recognized autoimmune systemic disorder that has been described in various organs. The disease is characterized histologically by a dense lymphoplasmocytic infiltrate of IgG4-positive cells, storiform fibrosis and can be associated with tumefactive lesions. IgG4-related disease involving the upper gastrointestinal tract is rare and only two previous case reports have reported IgG4-related esophageal disease. We report the case of a 63-year-old female patient with a long-standing history of severe dysphagia and odynophagia with an initial diagnosis of reflux esophagitis. Symptoms persisted despite anti-acid therapy and control esophagogastroduodenoscopy (EGD) revealed endoscopic images consistent with esophagitis dissecans superficialis (sloughing esophagitis). An underlying autoimmune process was suspected and immunosuppressant agents were tried to control her disease. The patient eventually developed disabling dysphagia secondary to multiple chronic esophageal strictures. A diagnosis of IgG4-related disease was eventually made after reviewing esophageal biopsies and performing an immunohistochemical study with an anti-IgG4 antibody. Treatment attempts with corticosteroids and rituximab was not associated with a significant improvement of the symptoms of dysphagia and odynophagia, possibly because of the chronic nature of the disease associated with a high fibrotic component. Our case report describes this unique case of IgG4-related esophageal disease presenting as chronic esophagitis dissecans with strictures. We also briefly review the main histopathological features and treatment options in IgG4-related disease. PMID:24883156

  6. Clinical features of eosinophilic esophagitis.

    PubMed

    Miehlke, Stephan

    2014-01-01

    Eosinophilic esophagitis (EoE) may affect individuals at any age with a predominance for Caucasian males. The clinical manifestation of EoE is strongly age dependent. While dysphagia and food impaction are typical lead symptoms in adults and adolescents, infants often present with unspecific symptoms such as feeding problems, abdominal pain and vomiting. Some EoE patients may also experience heartburn. Therefore, EoE should always be considered in cases of heartburn refractory to antireflux therapy. Concomitant allergic diseases such as asthma, rhinitis and eczema are prevalent. Peripheral eosinophilia and elevated total serum IgE values are found in up to 50 and 70% of cases, respectively. Endoscopic features of EoE are variable and none of them is pathognomonic. Frequent findings are mucosal edema, furrows, exudates and corrugated rings. These endoscopic abnormalities have high specificities (90-95%), but low sensitivities (15-48%). A novel grading and classification system for the endoscopic assessment of EoE has been proposed which includes fixed rings, exudates, furrows and edema as major features. This classification system demonstrated good interobserver agreement among pediatric and adult gastroenterologists, and presents a useful tool to standardize endoscopic assessments and to further investigate the relation between endoscopic manifestation, clinical activity and response to treatment in EoE. Long-term follow-up studies have shown that EoE is a chronic disease causing recurrent dysphagia in the majority of cases. The prevalence of strictures significantly increases with the duration of disease, which stresses the importance of early diagnosis and consequent treatment of EoE. PMID:24603382

  7. Structural and magnetic characterization of mixed valence Co(II, III)xZn1-xO epitaxial thin films

    NASA Astrophysics Data System (ADS)

    Negi, D. S.; Loukya, B.; Dileep, K.; Sahu, R.; Shetty, S.; Kumar, N.; Ghatak, J.; Pachauri, N.; Gupta, A.; Datta, R.

    2014-03-01

    In this article, we report on the Co atom incorporation, secondary phase formation and composition-dependent magnetic and optical properties of mixed valence Co(II, III)xZn1-xO epitaxial thin films grown by pulsed laser deposition. The intended total Co concentration is varied between ~6-60 at.% with relatively higher concentration of +3 over +2 charge state. Mixed valence Co(II, III) shows high solubility in ZnO (up to 38 at.%) and ferromagnetism is observed in samples with total Co incorporation of ~29 and 38 at.%. Electron diffraction pattern and high resolution transmission electron microscopy images reveal single crystalline nature of the thin films with wurtzite structure. Co oxide interlayer, with both rock salt and spinel structure, are observed to be formed between the substrate and wurtzite film for total Co concentration at ~17 at.% and above. Magnetization shows composition dependence with a saturation moment value of ~93 emu cm-3 and a coercive field of ~285 Oe observed for ~38 at.% Co:ZnO films. Ferromagnetism was not observed for films with Co concentration 17 and 9 at.%. The Co oxide interlayer does not show any ferromagnetism. All the films are n-type with carrier concentration ~1019 cm-3. The observed magnetism is probably resulting from direct antiferromagntic exchange interaction between Co2+ and Co3+ ions favored by heavy Co alloying giving rise to ferrimagnetism in the system.

  8. Novel ETF dehydrogenase mutations in a patient with mild glutaric aciduria type II and complex II-III deficiency in liver and muscle

    PubMed Central

    Wolfe, Lynne A.; He, Miao; Vockley, Jerry; Payne, Nicole; Rhead, William; Hoppel, Charles; Spector, Elaine; Gernert, Kim; Gibson, K. Michael

    2014-01-01

    We describe a 22-year-old male who developed severe hypoglycemia and lethargy during an acute illness at 4 months of age and subsequently grew and developed normally. At age 4 years he developed recurrent vomiting with mild hyperammonemia and dehydration requiring frequent hospitalizations. Glutaric aciduria Type II was suspected based upon biochemical findings and managed with cornstarch, carnitine and riboflavin supplements. He did not experience metabolic crises between ages 4-12 years. He experienced recurrent vomiting, mild hyperammonemia, and generalized weakness associated with acute illnesses and growth spurts. At age 18 years, he developed exercise intolerance and proximal muscle weakness leading to the identification of multiple acyl-CoAdehydrogenase and complex II/III deficiencies in both skeletal muscle and liver. Subsequent molecular characterization of the ETFDH gene revealed novel heterozygous mutations, p.G274X:c.820 G>T (exon 7) and p.P534L: c.1601 C>T (exon 12), the latter within the iron sulfur-cluster and predicted to affect ubiquinone reductase activity of ETFDH and the docking of ETF to ETFDH. Our case supports the concept of a structural interaction between ETFDH and other enzyme partners, and suggests that the conformational change upon ETF binding to ETFDH may play a key role in linking ETFDH to II/III super-complex formation. PMID:21088898

  9. Eosinophilic Esophagitis: Interactions with Gastroesophageal Reflux Disease

    PubMed Central

    Cheng, Edaire; Souza, Rhonda F.; Spechler, Stuart Jon

    2014-01-01

    Synopsis Early authorities on eosinophilic esophagitis (EoE) deemed it crucial to distinguish this disorder from gastroesophageal reflux disease (GERD). However, it has become clear that GERD and EoE are not mutually exclusive disorders, and that their interactions can be complex. The notion that GERD and EoE can be distinguished by the response to PPI treatment is based on the assumption that gastric acid suppression is the only important therapeutic effect of PPIs, and therefore only GERD can respond to PPIs. This assumption appears to be incorrect for two major reasons. First, there are multiple mechanisms whereby PPI-induced acid reduction might benefit patients with EoE. Second, PPIs have acid-independent, anti-inflammatory effects that might be beneficial both for GERD and for EoE. Since the PPIs have multiple effects that might benefit both diseases, for patients who have esophageal symptoms and esophageal eosinophilia, we feel that a clinical and/or histological response to PPIs does not rule in GERD, and does not rule out EoE. However, we do recommend a trial of PPI therapy for patients with symptomatic esophageal eosinophilia, even if the diagnosis of EoE seems clear-cut. PMID:24813513

  10. Esophageal cancer revealing a tracheal diverticulum

    PubMed Central

    Zhang, Miao; Wang, Heng; Wu, Wen-Bin

    2015-01-01

    Tracheal diverticulum is a benign entity characterized by single or multiple invaginations of the tracheal wall, and is rarely encountered in clinical practice but frequently in postmortem examination as an incidental finding. Its combination with esophageal cancer is extremely rare. In this case report, we present a patient with these two lesions and analyze their correlation. PMID:25973258

  11. Esophageal function testing: beyond manometry and impedance.

    PubMed

    Mittal, Ravinder K

    2014-10-01

    Manometry and impedance provide only surrogate information regarding longitudinal wall function and are focused on contractile amplitude and lumen content. Ultrasound imaging provides a unique perspective of esophageal function by providing important information regarding longitudinal muscle contraction. Laser Doppler assessment of perfusion may be an important complementary tool to assess abnormal wall blood perfusion as a possible mechanism of pain. PMID:25216911

  12. Eosinophilic esophagitis: asthma of the esophagus?

    Microsoft Academic Search

    AMINDRA S. ARORA; Kiyoshi Yamazaki

    2004-01-01

    Eosinophilic esophagitis (EE) is rapidly emerging as a distinct disease entity in both pediatric and adult gastroenterology. The typical clinical presentation includes solid food dysphagia in young men who have an atopic predisposition. Food impaction necessitating endoscopic intervention is common. EE should be suspected, in particular, in patients with unexplained dysphagia or those with no response to antacid or anti-acid

  13. Histomorphological and Immunophenotypic Features of Pill-Induced Esophagitis

    PubMed Central

    Kim, Su Hwan; Kim, Won; Lee, Kook Lae; Byeon, Sun-ju; Choi, Euno; Chang, Mee Soo

    2015-01-01

    The aim of this study was to investigate histomorphological and immunophenotypic features in pill-induced esophagitis. We comparatively evaluated the histomorphological, immunophenotypic features of pill-induced esophagitis vs. reflux esophagitis, as well as clinical information and endoscopic findings. Fifty-two tissue pieces from 22 cases of pill-induced esophagitis, 46 pieces from 20 reflux esophagitis, and 16 pieces from 14 control samples were subjected to immunohistochemistry for inflammatory infiltrates (CD3 for T lymphocyte, CD20 for B lymphocyte, CD56 for NK cell, CD68 for macrophage, CD117 for mast cell) and eosinophil chemotaxis-associated proteins (Erk, leptin, leptin receptor, pSTAT3, phospho-mTOR). As a result, Histomorphology showed that a diffuse pattern of dilated intercellular spaces was more frequently observed in pill-induced esophagitis, while reactive atypia and subepithelial papillary elongation were more often found in reflux esophagitis (P < 0.05, respectively). Interestingly, intraepithelial eosinophilic microabscess, intraepithelial pustule and diffuse pattern of dilated intercellular spaces were observed in 14% (3 cases), 9% (2 cases) and 32% (7 cases) of pill-induced esophagitis, respectively, but in no cases of reflux esophagitis. Regarding intraepithelial inflammatory infiltrates in pill-induced esophagitis, T lymphocytes were the most common cells, followed by eosinophil; 11 and 7 in one x400 power field, respectively. Intraepithelial pSTAT3-positive pattern was more frequently observed in pill-induced esophagitis than in reflux esophagitis, at 45% (10 cases) versus 10% (2 cases), respectively (P < 0.05). Considering the distal esophageal lesion only, intraepithelial pustule, diffuse dilated intercellular spaces and stromal macrophages were more frequently found in distal pill-induced esophagitis, whereas reactive atypia and intraepithelial mast cells in reflux esophagitis (P < 0.05, respectively). In conclusion, diffuse dilated intercellular spaces, intraepithelial eosinophil microabscess, pustule, T lymphocytes, eosinophils, and pSTAT3 positivity can be added to histopathological features of pill-induced esophagitis, other than non-specific ulcer. Besides, distal pill-induced esophagitis may be histopathologically differentiated from reflux esophagitis. PMID:26047496

  14. Rare complication of percutaneous endoscopic gastrostomy: Ostomy metastasis of esophageal carcinoma.

    PubMed

    Sousa, Ana Lúcia; Sousa, Diamantino; Velasco, Francisco; Açucena, Francisco; Lopes, Ana; Guerreiro, Horácio

    2013-11-15

    The authors present the case of a 55-year-old male with a stage III (T4N1M0) squamous-cell esophageal carcinoma, who underwent percutaneous endoscopic gastrostomy (PEG). The pull method of tube placement was used. Five months after the procedure, the patient was referred to the hospital with a hard palpable tumour at the ostomy site. The histologic exam revealed an abdominal wall metastasis of the esophageal cancer. The authors present this case because of the rarity of metastasis in ostomy after placement of PEG in patients with tumours located in the head and neck. In this particular context and judging by the rarity of situation, the clinical impact of this phenomenon is limited. Nevertheless, metastasis in ostomy site could be prevented by the push method, laparoscopy or laparotomy. PMID:24244807

  15. Prognostic Value of the Maximum Standardized Uptake Value on Positron Emission Tomography for Esophageal Squamous Cell Carcinoma.

    PubMed

    Jeon, Hyun Woo; Kim, Kyung Soo; Sung, Sook Whan; Park, Hyung Joo; Kim, Young-Du; Park, Jae Kil

    2015-06-01

    Background?Esophageal cancer is a malignant tumor with one of the worst prognosis. Positron emission tomography (PET) reveals the degree of metabolic activity of tumor cells. We hypothesized that a high maximum standardized uptake value (SUVmax) on PET would predict a poor clinical outcome. Methods?From November 2004 to August 2011, we reviewed 88 patients with esophageal squamous cell carcinoma who underwent preoperative PET followed by surgery. SUVmax values of primary sites were measured. The patients were divided into two groups with median SUVmax as a cutoff value and outcomes were compared. Results?The median SUVmax was 6.35. Cervical and upper thoracic cancer, large tumor size, stage ??T2, and lymph node metastasis were significantly associated with the high SUVmax group. Cervical and upper thoracic cancer (p?=?0.038), SUVmax (p?=?0.038), number of lymph nodes dissected (p?=?0.009), stage???T2 (p?=?0.003), lymph node metastasis (p?stage???T2 (p?=?0.025) were significantly associated with overall survival by multivariate analysis. Conclusion?High preoperative SUVmax on PET predicts advanced T stage and worse prognosis. SUVmax on PET may provide useful information combined with current stage for determining optimal treatment in esophageal cancer. PMID:25322264

  16. Unilateral Cervical Nodal Metastasis Is an Independent Prognostic Factor for Esophageal Squamous Cell Carcinoma Patients Undergoing Chemoradiotherapy: A Retrospective Study

    PubMed Central

    Zhao, Lei; Li, Qiao-Qiao; He, Liru; Liu, Shiliang; Shen, Jingxian; Liu, Meng-Zhong

    2014-01-01

    Purpose To determine the prognostic significance of unilateral cervical lymph nodal metastasis (CLNM) in patients with inoperable thoracic esophageal squamous cell carcinoma (SCC) and to identify significant prognostic factors in these patients. Patients and methods This retrospective study involved 395 patients with inoperable esophageal SCC treated with concurrent chemoradiotherapy. The patients were classified into three groups according to their cervical lymph node status: group A, no evidence of CLNM; group B, unilateral CLNM; group C, other distant metastases. Overall survival (OS) and progression-free survival (PFS) were calculated. Significant prognostic factors were identified using univariate and multivariate analyses. Results The 3-year OS rates in groups A, B and C were 46.7%, 33.5% and 8.3%, respectively (p<0.001, log-rank test). The corresponding PFS rates were 40.7%, 26.4% and 4.7% (p<0.001, log-rank test). Group B had a similar prognosis to that of group A and better 3-year OS (p?=?0.009) and PFS (p?=?0.006) rates than those of group C. Multivariate analysis demonstrated that T stage, chemotherapy regimen and cervical lymph node involvement were independent prognostic factors affecting OS and PFS. Conclusions Compared to other distant metastases, unilateral CLNM is associated with longer OS in esophageal SCC and should be regarded as a regional disease. Sex, T stage, concurrent chemotherapy modality and cervical lymph node involvement are independent predictors of survival in esophageal SCC. PMID:24979040

  17. Does surgery correct esophageal motor dysfunction in gastroesophageal reflux

    SciTech Connect

    Russell, C.O.; Pope, C.E.; Gannan, R.M.; Allen, F.D.; Velasco, N.; Hill, L.D.

    1981-09-01

    The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

  18. Non-invasive Predictors of Esophageal Varices

    PubMed Central

    Cherian, Jijo V.; Deepak, Nandan; Ponnusamy, Rajesh Prabhu; Somasundaram, Aravindh; Jayanthi, V.

    2011-01-01

    Background/Aim: Current guidelines recommend screening cirrhotic patients with an endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices. In this study, we aimed at identifying non-endoscopic parameters that could predict the presence and grades of esophageal varices. Patients and Methods: In a prospective study, 229 newly diagnosed patients with liver cirrhosis, without a history of variceal bleeding, were included. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. Esophageal varices were classified as small and large, at endoscopy. Univariate analysis and multivariate logistic regression analysis were done to identify independent predictors for the presence and grades of varices. Results: Of the 229 patients (141 males; median age 42 years; range 17-73 years) with liver cirrhosis, 97 (42.3%) had small and 81 (35.4%) had large varices. On multivariate analysis, low platelet count (Odd’s Ratio [OR], 4.3; 95% confidence interval [CI], 1.2-14.9), Child Pugh class B/C (OR, 3.3; 95% CI, 1.8-6.3), spleen diameter (OR, 4.3; 95% CI, 1.6-11.9) and portal vein diameter (OR, 2.4; 95% CI, 1.1-5.3) were independent predictors for the presence of varices. Likewise, for the presence of large esophageal varices, low platelet count (OR, 2.7; 95% CI, 1.4-5.2), Child Pugh class B/C (OR, 3.8; 95% CI, 2.3-6.5) and spleen diameter (OR, 3.1; 95% CI, 1.6-6.0) were the independent risk factors. Conclusion: The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices. PMID:21196656

  19. Laparoscopic heller myotomy and fundoplication in patients with end-stage achalasia.

    PubMed

    Herbella, Fernando A M; Patti, Marco G

    2015-07-01

    Achalasia may present in a non-advanced or advanced (end stage) stage. The latter is characterized by massive esophageal dilatation and/or the loss of the esophageal straight axis (sigmoid-shaped esophagus). The treatment for non-advanced cases of achalasia is well defined while the therapy for end-stage disease is still debatable. Laparoscopic Heller's myotomy is an option in patients with end-stage achalasia. Dysphagia is relieved in a significant number of patients, it is a simpler operation to be used in frail patients, and it does not preclude a latter esophagectomy if necessary. PMID:25566981

  20. Diffuse esophageal intramural pseudodiverticulosis and nutcracker esophagus in a 54-year-old man.

    PubMed

    Walker, S; Hippéli, R; Goës, R

    1990-02-01

    Esophageal intramural pseudodiverticulosis, which was first described by Mendl et al. in 1960, is characterized by multiple small flask-shaped outpouchings in the esophageal wall. The pseudodiverticula represent dilated excretory ducts of deep mucous glands in the esophagus. The etiology of this rare condition is unknown. Hiatal hernias, gastroesophageal reflux, esophageal strictures, candida esophagitis, herpes esophagitis, diabetes mellitus, and chronic alcoholism have been found associated with intramural pseudodiverticulosis. We report the second case of esophageal hypermotility in intramural pseudodiverticulosis. PMID:2107356

  1. Overexpression of interleukin-8 receptor 2 (IL-8R2) indicates better prognosis in esophageal adenocarcinoma and squamous cell carcinoma procession.

    PubMed

    Liang, Bing; Zhao, Hui; Che, Jian-Bo; Wang, Hao-Jie; Shi, Gong-Ning

    2014-08-01

    Researches have showed that interleukin family or receptors play a role in many human tumor progressions including esophageal carcinoma. In this study, we examined the expression of interleukin-8 receptor 2 (IL-8R2) and analyze the relationship between it and esophageal carcinoma clinical characteristics. IL-8R2 protein expression was confirmed by immunohistochemistry and immunofluorescence arrays and was analyzed further via Western blot and qRT-PCR analysis in frozen tissues. The correlation between their expression levels and clinical characteristics were evaluated by Mann-Whitney and Kruskal-Wallis test. Via Kaplan-Meier plots and Cox proportional hazard models, overall survival (OS) was analyzed. Compared with normal esophageal tissue, IL-8R2 protein was overexpressed significantly in esophageal cancer (p < 0.05) and was observed both in cytoplasm and nuclear. The lower expression of IL-8R2 protein was observed with higher p staging of esophageal cancer, and the significant association between them was confirmed (p = 0.000), and in advanced p T stage, the similar result was obtained (p = 0.015); however, compared with lymph node metastasis-negative group, it is no significant difference in positive group (p = 0.152). In a Kaplan-Meier analysis, compared with IL-8R2 low expression, IL-8R2 high expression identified a group of patients with the longest OS. Cox proportional hazard models revealed that IL-8R2 predicted long time to OS. The higher expression of IL-8R2 was found in early esophageal carcinoma, which may indicate that IL-8R2 plays an important role and is better prognostic factor in esophageal cancer development. PMID:24972913

  2. [Complexes of cobalt (II, III) with derivatives of dithiocarbamic acid--effectors of peptidases of Bacillus thuringiensis and alpha-L-rhamnozidase of Eupenicillium erubescens and Cryptococcus albidus].

    PubMed

    Varbanets, L D; Matseliukh, E V; Se?fullina, I I; Khitrich, N V; Nidialkova, N A; Hudzenko, E V

    2014-01-01

    The influence of cobalt (II, III) coordinative compounds with derivatives of dithiocarbamic acid on Bacillus thuringiensis IMV B-7324 peptidases with elastase and fibrinolytic activity and Eupenicillium erubescens and Cryptococcus albidus alpha-L-rhamnosidases have been studied. Tested coordinative compounds of cobalt (II, III) on the basis of their composition and structure are presented by 6 groups: 1) tetrachlorocobaltates (II) of 3,6-di(R,R')-iminio-1,2,4,5-tetratiane--(RR')2Ditt[CoCl4]; 2) tetrabromocobaltates (II) of 3,6-di(R,R')-iminio-1,2,4,5-tetratiane--(RR')2Ditt[CoBr4]; 3) isothiocyanates of tetra((R,R')-dithiocarbamatoisothiocyanate)cobalt (II)--[Co(RR'Ditc)4](NCS)2]; 4) dithiocarbamates of cobalt (II)--[Co(S2CNRR')2]; 5) dithiocarbamates of cobalt (III)--[Co(S2CNRR')3]; 6) molecular complexes of dithiocarbamates of cobalt (III) with iodine--[Co(S2CNRR')3] x 2I(2). These groups (1-6) are combined by the presence of the same complexing agent (cobalt) and a fragment S2CNRR' in their molecules. Investigated complexes differ by a charge of intrinsic coordination sphere: anionic (1-2), cationic (3) and neutral (4-6). The nature of substituents at nitrogen atoms varies in each group of complexes. It is stated that the studied coordination compounds render both activating and inhibiting effect on enzyme activity, depending on composition, structure, charge of complex, coordination number of complex former and also on the enzyme and strain producer. Maximum effect is achieved by activating of peptidases B. thuringiensis IMV B-7324 with elastase and fibrinolytic activity. So, in order to improve the catalytic properties of peptidase 1, depending on the type of exhibited activity, it is possible to recommend the following compounds: for elastase--coordinately nonsaturated complexes of cobalt (II) (1-4) containing short aliphatic or alicyclic substituents at atoms of nitrogen and increasing activity by 17-100% at an average; for fibrinolytic--neutral dithiocarbamates of cobalt (II, III) (4-5) (by 29-199%). For increasing the fibrinolytic activity of peptidase it is better to use dibenzyl- or ethylphenyldithiocarbamates of cobalt (III), which increase activity by 15-40% at an average. The same complexes, and also compound {(CH2)6}2Ditt[CoCl4] make an activating impact on alpha-L-rhamnosidase C. albidus (by 10-20%). PMID:25033554

  3. Robot assisted thoracoscopic resection of giant esophageal leiomyoma

    PubMed Central

    Compean, Steven D.; Gaur, Puja; Kim, Min P.

    2014-01-01

    INTRODUCTION Esophageal leiomyoma represents the most common benign esophageal tumor. Robot-assisted thoracoscopic surgery has provided ability to remove it successfully using a minimally invasive approach. PRESENTATION OF CASE A 63-year old female with history of chronic chest pain presented with an esophageal mass on chest CT and endoscopic ultrasound. Robot-assisted surgery was performed using three robot arms, a camera and an assistant port. A 10 cm leiomyoma was enucleated and removed through a 2 cm myotomy. Completion endoscopy confirmed integrity of the esophagus. Patient's chest pain resolved postoperatively, and she was discharged on postoperative day 3. DISCUSSION Our case describes successful removal of the giant esophageal leiomyoma (10 cm) by robot assisted minimally invasive resection through a 2 cm myotomy. CONCLUSION Use of robot allows for removal of large esophageal leiomyoma. The improved dexterity and patient outcome offered by robot suggests its potential as the mainstay technique for giant esophageal leiomyoma removal. PMID:25460487

  4. Esophageal perforation. An unusual presentation with a benign clinical course.

    PubMed

    DeLuca, R F; Tedesco, F J; Ballan, K; Wortzel, E; Rogers, A I

    1977-04-01

    A case of esophageal perforation occurring in a 75-year-old man is presented. The clinical presentation was benign and the diagnosis of esophageal perforation was made incidental to an upper gastrointestinal barium examination. Conservative management consisting of nasogastric suctioning, antibiotics and antacids was effective in minimizing the clinical course. This represents a rare instance of a successful nonsurgical approach to esophageal perforation. PMID:879153

  5. Ambulatory 24-hour esophageal pH monitoring

    Microsoft Academic Search

    G. J. Wiener; T. M. Morgan; J. B. Copper; D. O. Castell; J. W. Sinclair; J. E. Richter

    1988-01-01

    If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject

  6. Expression of cyclooxygenase-2 in human esophageal squamous cell carcinomas

    Microsoft Academic Search

    Jian-Gang Jiang; Jiang-Bo Tang; Chun-Lian Chen; Bao-Xing Liu; Xiang-Ning Fu; Zhi-Hui Zhu; Wei Qu; Katherine Cianflone; Michael P. Waalkes; Dao-Wen Wang

    2004-01-01

    AIM: To determine whether cyclooxygenase-2 (COX-2) was expressed in human esophageal squamous cell carcinoma. METHODS: Quantitative reverse transcription-polymerase chain reaction (RT-PCR), western blotting, immunohistoc- hemistry and immunofluorescence were used to assess the expression level of COX-2 in esophageal tissue. RESULTS: COX-2 mRNA levels were increased by >80-fold in esophageal squamous cell carcinoma when compared to adjacent noncancerous tissue. COX-2 protein

  7. Altered esophageal pain threshold in irritable bowel syndrome

    Microsoft Academic Search

    Mario Costantini; Giacomo Carlo Sturniolo; Giovanni Zaninotto; Renata D'Incà; Rita Polo; Remo Naccarato; Ermanno Ancona

    1993-01-01

    Gut motility disorders and altered pain perception were reported in patients with irritable bowel syndrome (IBS). To verify foregut involvement in IBS, we studied 30 patients using esophageal manometry and 24-hr pH monitoring of the distal esophagus. Two subgroups of patients underwent esophageal provocative tests (bethanechol 50 µg\\/kg subcutaneously and esophageal balloon distension test). Twelve healthy volunteers formed a control

  8. Botulinum toxin use in pediatric esophageal achalasia: A case report

    Microsoft Academic Search

    J. M Walton; G Tougas

    1997-01-01

    Esophageal achalasia (EA) has been historically treated by esophageal dilatation or myotomy with or without fundoplication. Botulinum toxin (Botox-Allergan) use in pediatric EA has not been previously described. The authors' objective was to observe the efficacy of botulinum toxin injection into the lower esophageal sphincter (LES) for EA. An 11-year-old boy presented with a 9-month history of frequent pneumonia, productive

  9. Esophageal motility impairment in plummer-vinson syndrome

    Microsoft Academic Search

    Roberto O. Dantas; Marcia G. Villanova

    1993-01-01

    Summary We report the case of a 41-year-old woman with Plummer-Vinson syndrome and an esophageal motility disorder. She complained of dysphagia and odynophagia and had cheilitis, glossitis, and hypochromic anemia. An esophageal motility study showed low amplitude of contraction and high intrabolus pressure in the esophageal body. After iron replacement, the patient was free from symptoms, and a new motility

  10. Molecular factors related to metastasis of esophageal squamous cell carcinoma

    Microsoft Academic Search

    Yutaka Shimada; Fumiaki Sato

    2007-01-01

    The aggressive behavior of esophageal cancer leads to a low survival rate for patients with this disease. Isolated esophageal\\u000a cancer cells seem to have the potential for regrowth and metastasis. To control the metastasis of esophageal carcinoma, detailed\\u000a analysis of various molecular and biological factors should be done in each patient. Recent progress in molecular biology\\u000a has revealed that oncogenes,

  11. Endoscopic palliation of advanced esophageal cancer

    PubMed Central

    Mocanu, A; Bârla, R; Hoara, P; Constantinoiu, S

    2015-01-01

    Esophageal cancer represents one of the most aggressive digestive tumors, with a survival rate at 5 years of only 10%. Globally, during the last three decades, there has been an increasing incidence of the esophageal cancer, approx. 400,000 new esophageal cancers being currently diagnosed annually. This represents the eighth leading cause of cancer incidence and the sixth leading cause of cancer death overall. Taking into account the population’s global aging and thus, the increase in the number of patients who will not bear surgery, PCT and radiation, or the fact that they do not want it especially because of deficiencies and associated pathology, the endoscopic ablative techniques with palliation purposes represent the alternative. If we refer to the Western Europe countries and North America, we notice an increase of esophageal adenocarcinoma rate versus squamous cancer. As for the Asian region, referring in particular to China and Japan, 9 out of 10 esophageal cancers are squamous cell carcinomas. For at least half of the patients with EC (esophageal cancer) there is no hope of healing because of the advanced regional malignant invasion (T3-4, N+, M+) with no chemo and radiotherapy response, poor preoperative patients’ conditions or systemic metastasis. The low life expectancy does not justify the risky medical procedures, the goal of the therapy consisting in the improvement of the quality of life by eliminating dysphagia (reestablishing oral feeding) which represents the most common complication of EC, the respiratory tract complication caused by eso-tracheal fistulas or by eliminating chest pain. To treat dysphagia, which is the main target of palliation, combined methods like endoscopic, chemo and radio-therapy, can be used, each one with indications, benefits and risks. Abbreviations: SEPS = self expanding plastic stent, SREMS = self expanding metal stent, EBRT = Endoscopic brachy radiotherapy, EUS = Ultra sound endoscopy, CT = Computer tomograph, UGE = Upper gastro endoscopy, PET-CT = Positron Emission Tomography, APC = argon plasma coagulation, PDT = photo dynamic therapy, PCT = Poli-chemotherapy, RT = Radio-therapy PMID:25866578

  12. Gastroesophageal scintigraphy and endoscopy in the diagnosis of esophageal reflux and esophagitis

    SciTech Connect

    Fung, W.P.; Van der Schaaf, A.; Grieve, J.C.

    1985-04-01

    The value of gastroesophageal (G/E) scintigraphy in the diagnosis of gastroesophageal reflux was assessed in 51 subjects, who presented with heartburn and had endoscopic evidence of reflux esophagitis. G/E scintigraphy was done using /sup 99m/Tc sulfur-colloid in acidified orange juice. The G/E reflux index was calculated according to previous reports. The mean (+/- SD) G/E reflux index in 18 patients with severe esophagitis and 30 patients with moderate esophagitis were 1.6% (+/- 1.5) and 3.2% (+/- 5.0), respectively. The mean G/E reflux index in 14 control subjects was 2.4% (+/- 1.1). There was no significant difference between the esophagitis and control groups. Furthermore, if 4% was taken as upper limit of normal, this will include almost all the esophagitis patients and controls. It is concluded that the G/E reflux index based on G/E scintigraphy is of little value in the diagnosis of G/E reflux.

  13. Esophageal Motor Disorders in Terms of High-Resolution Esophageal Pressure Topography: What Has Changed?

    PubMed Central

    Kahrilas, Peter J.

    2010-01-01

    The concept of high-resolution manometry (HRM) is to use sufficient pressure sensors such that intraluminal pressure can be monitored as a continuum along luminal length much as time is viewed as a continuum in conventional manometry. When HRM is coupled with pressure topography plots, pressure amplitude is transformed into spectral colors with isobaric conditions indicated by same-colored regions on the display. Together, these technologies are called high-resolution esophageal pressure topography (HREPT). HREPT has several advantages compared with conventional manometry, the technology that it was designed to replace. (i) The contractility of the entire esophagus can be viewed simultaneously in a uniform format, (ii) standardized objective metrics can be systematically applied for interpretation, and (iii) topographic patterns of contractility are more easily recognized and have greater reproducibility than with conventional manometry. Compared with conventional manometry, HREPT has improved sensitivity for detecting achalasia, largely due to the objectivity and accuracy with which it identifies impaired esophagogastric junction (EGJ) relaxation. In addition, it has led to the subcategorization of achalasia into three clinically relevant subtypes based on the contractile function of the esophageal body: classic achalasia, achalasia with esophageal compression, and spastic achalasia. Headway has also been made in understanding hypercontractile conditions, including diffuse esophageal spasm and a newly described entity, spastic nutcracker. Ultimately, clinical experience will be the judge, but it seems likely that HREPT data, along with its well-defined functional implications, will improve the clinical management of esophageal motility disorders. PMID:20179690

  14. Esophageal Carcinoma in African Americans: A Five-Decade Experience

    Microsoft Academic Search

    Hassan Ashktorab; Zahra Nouri; Mehdi Nouraie; Hadi Razjouyan; Edward E. Lee; Ehsan Dowlati; El-Waleed El-Seyed; Adeyinka Laiyemo; Hassan Brim; Duane T. Smoot

    Background  Esophageal cancer accounts for a considerable proportion of carcinomas of the upper gastrointestinal tract in African Americans.\\u000a Our aim was to describe the epidemiology of esophageal squamous cell cancer (ESCC) and esophageal adenocarcinoma (EA) among\\u000a African Americans in the last five decades.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A total of 601 records of patients with documented esophageal cancer between 1959 and 2007 at Howard University

  15. Eosinophilic esophagitis as paraneoplastic syndrome in a patient with ganglioneuroblastoma.

    PubMed

    Prader, S; Spalinger, J; Caduff, J; Hürlimann, S; Rischewski, J

    2015-05-01

    A 16-month-old boy presented with failure to thrive despite sufficient caloric intake, hypersalivation, abdominal pain, chronic diarrhea and blepharitis. An eosinophilic esophagitis (EoE) was diagnosed by esophageal biopsy. Dietary restrictions and topical steroid treatment lead to no improvement. Further diagnostic work-up revealed an intrathoracal, paraspinal ganglioneuroblastoma. After operative extirpation of the tumour, all initial symptoms resolved. An esophageal control biopsy 4 weeks after tumour resection was normal. This is the first report of eosinophilic esophagitis as part of a paraneoplastic syndrome in a patient with a malignant disease other than a carcinoma. PMID:25985452

  16. Investigation of intra-esophageal air kinetics and esophageal sphincters in patients with total laryngectomy during esophageal speech.

    PubMed

    Bozan, Aykut; Vardar, Rukiye; Akyildiz, Serdar; Kirazli, Tayfun; Ogut, Fatih; Yildirim, Esra; Bor, Serhat

    2015-08-01

    The purpose of this study was to evaluate the air kinetics of well- and poor-speaking patients and their upper (UES) and lower (LES) esophageal sphincter pressures . The esophageal speech capability of 23 total laryngectomy patients was assessed with the Wepman scale. LES and UES points and pressures were measured, and air kinetics were compared. All patients were male, with an average age of 58 years. Both the LES and UES pressures were not statistically different between good-speaking and poor-speaking patients (p > 0.05). The ability to speak was estimated only by looking at tracings. Good speakers are able to retain air successfully and on a long-term basis between the upper and lower esophageal sphincters. During short and/or rapid speech, these patients are able to rapidly suck and then expel the air from their upper esophagus. During long speeches, after sucking the air into their distal esophagus, they used the air in the upper part of the esophagus during the speech, only later seeming to fill the lower esophagus with the air as a possible reserve in the stomach. It has been shown that the basic requirement for speaking is the capacity to suck and store the air within the esophagus. For successful speech, the air should be stored inside the esophagus. MII technology contributes to our understanding of speech kinetics and occupies an important place in patient training as a biofeedback technique. PMID:25763572

  17. Activation of type-1 cannabinoid receptor shifts the balance between excitation and inhibition towards excitation in layer II/III pyramidal neurons of the rat prelimbic cortex.

    PubMed

    den Boon, Femke S; Werkman, Taco R; Schaafsma-Zhao, Qiluan; Houthuijs, Kas; Vitalis, Tania; Kruse, Chris G; Wadman, Wytse J; Chameau, Pascal

    2015-07-01

    Activation of the endocannabinoid (eCB) system by exogenous cannabinoids (drug abuse) can alter the physiology of the brain circuits involved in higher-order cognitive functions such as the medial prefrontal cortex (mPFC). A proper balance between excitation and inhibition (E/I balance) is critical for neuronal network oscillations underlying cognitive functions. Since type-1 cannabinoid receptors (CB1Rs), expressed in many brain areas including the mPFC, can modulate excitatory and inhibitory neurotransmission, we aimed to determine whether CB1R activation results in modifications of the E/I balance. We first confirm the presence of functional presynaptic CB1Rs that can modulate both excitatory and inhibitory inputs to layer II/III pyramidal neurons of the prelimbic (PL) area of the mPFC. By decomposing the synaptic response evoked by layer I stimulation into its excitatory and inhibitory components, we show that in vitro CB1R activation with the cannabinoid receptor agonists WIN55,212-2 (WIN) and CP-55940 (CP) modulates the balance between excitation and inhibition (E/I balance) of layer II/III pyramidal neurons. This treatment caused a significant shift of the E/I balance towards excitation, from 18/82 % to 25/75 % (WIN) and from 17/83 to 30/70 % (CP). Finally, when animals were injected with a cannabinoid receptor agonist, we observed a shift of the E/I balance (measured in vitro) towards excitation 1 h after WIN (24/76 %) or after CP injection (30/70 %) when compared to vehicle-injected animals (18/82 %). This modulation of the E/I balance by CB1Rs may thus be fundamental in the regulation of local PL cortical network excitability and could be the mechanism through which excessive CB1R activation (cannabis abuse) affects cognitive functions. PMID:25081244

  18. Eosinophils in the Esophagus—Peptic or Allergic Eosinophilic Esophagitis? Case Series of Three Patients with Esophageal Eosinophilia

    Microsoft Academic Search

    Peter Ngo; Glenn T. Furuta; Donald A. Antonioli; Victor L. Fox

    2006-01-01

    OBJECTIVES:Scattered eosinophils in the distal esophagus traditionally provide the hallmark for peptic esophagitis, but the upper limit of eosinophils and the longitudinal extent of peptic inflammation along the esophagus are unknown. Recently, adults and children with upper intestinal symptoms and >20 eosinophils\\/high-power field (eos\\/HPF) have been given the diagnosis of allergic esophagitis. Standardized diagnostic criteria for allergic esophagitis are lacking

  19. Eosinophilic Esophagitis in Brazilian Pediatric Patients

    PubMed Central

    Pinheiro, Mayra Isabel Correia; de Góes Cavalcanti, Luciano Pamplona; Honório, Rodrigo Schuler; de Alencar Moreno, Luís Hélder; Fortes, Mayara Carvalho; da Silva, Carlos Antônio Bruno

    2013-01-01

    We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils. PMID:24106430

  20. Esophageal perforation in a sword swallower.

    PubMed

    Scheinin, S A; Wells, P R

    2001-01-01

    We present the case of a 59-year-old man who sustained an esophageal perforation as a result of sword swallowing. An esophagogram established the diagnosis, and surgical repair was attempted. However, 19 days later, a persistent leak and deterioration of the patient's condition necessitated a transhiatal esophagectomy with a left cervical esophagogastrostomy. The patient recovered and has resumed his daily activities at the circus, with the exception of sword swallowing. This case report presents an unusual mechanism for a potentially lethal injury. Our search of the English-language medical literature revealed no other report of esophageal perforation resulting from sword swallowing. Management of such an injury is often difficult, and a favorable outcome is dependent on prompt diagnosis and treatment. PMID:11330747

  1. Esophageal Perforation in a Sword Swallower

    PubMed Central

    Scheinin, Scott A.; Wells, Patrick R.

    2001-01-01

    We present the case of a 59-year-old man who sustained an esophageal perforation as a result of sword swallowing. An esophagogram established the diagnosis, and surgical repair was attempted. However, 19 days later, a persistent leak and deterioration of the patient's condition necessitated a transhiatal esophagectomy with a left cervical esophagogastrostomy. The patient recovered and has resumed his daily activities at the circus, with the exception of sword swallowing. This case report presents an unusual mechanism for a potentially lethal injury. Our search of the English-language medical literature revealed no other report of esophageal perforation resulting from sword swallowing. Management of such an injury is often difficult, and a favorable outcome is dependent on prompt diagnosis and treatment. PMID:11330747

  2. Peroral endoscopic myotomy for esophageal achalasia

    PubMed Central

    Inoue, Haruhiro; Ikeda, Haruo; Sato, Hiroki; Sato, Chiaki; Hokierti, Chananya

    2014-01-01

    Peroral endoscopic myotomy (POEM) is one of the alternative treatment for achalasia. Due to concept of natural orifice transluminal endoscopic surgery (NOTES), it becomes popular and widely accepted. With the endoluminal technique, submucosal tunnel was created followed by endoscopic myotomy. POEM is not only indicated in classical achalasia but also other abnormal esophageal motility disorders. Moreover, failures of endoscopic treatment or surgical attempted cases are not contraindicated for POEM. The second attempted POEM is also safe and technically feasible. Even though the legend of success of POEM is fruitful, the possible complications are very frightened. Good training and delicate practice will reduce rate of complications. This review provides a summary of current state-of-the-art of POEM, including indication equipments, technique and complications. This perfect procedure may become the treatment of choice of achalasia and some esophageal motility disorders in the near future. PMID:25333007

  3. Successful tubes treatment of esophageal fistula

    PubMed Central

    Zhou, Ning; Chen, Wei-xing; Li, You-ming; Xiang, Zhun; Gao, Ping; Fang, Ying

    2007-01-01

    Aim: To discuss the merits of “tubes treatment” for esophageal fistula (EF). Methods: A 66-year-old female who suffered from a bronchoesophageal and esophagothoratic fistula underwent a successful “three tubes treatment” (close chest drainage, negative pressure suction at the leak, and nasojejunal feeding tube), combination of antibiotics, antacid drugs and nutritional support. Another 55-year-old male patient developed an esophagopleural fistula (EPF) after esophageal carcinoma operation. He too was treated conservatively with the three tubes strategy as mentioned above towards a favorable outcome. Results: The two patients recovered with the tubes treatment, felt well and became able to eat and drink, presenting no complaint. Conclusion: Tubes treatment is an effective basic way for EF. It may be an alternative treatment option. PMID:17910112

  4. Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries

    PubMed Central

    Domper Arnal, María José; Ferrández Arenas, Ángel; Lanas Arbeloa, Ángel

    2015-01-01

    Esophageal cancer is one of the most unknown and deadliest cancers worldwide, mainly because of its extremely aggressive nature and poor survival rate. Esophageal cancer is the 6th leading cause of death from cancer and the 8th most common cancer in the world. The 5-year survival is around 15%-25%. There are clear differences between the risk factors of both histological types that affect their incidence and distribution worldwide. There are areas of high incidence of squamous cell carcinoma (some areas in China) that meet the requirements for cost-effectiveness of endoscopy for early diagnosis in the general population of those areas. In Europe and United States the predominant histologic subtype is adenocarcinoma. The role of early diagnosis of adenocarcinoma in Barrett’s esophagus remains controversial. The differences in the therapeutic management of early esophageal carcinoma (high-grade dysplasia, T1a, T1b, N0) between different parts of the world may be explained by the number of cancers diagnosed at an early stage. In areas where the incidence is high (China and Japan among others) early diagnoses is more frequent and has led to the development of endoscopic techniques for definitive treatment that achieve very effective results with a minimum number of complications and preserving the functionality of the esophagus. PMID:26185366

  5. Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries.

    PubMed

    Domper Arnal, María José; Ferrández Arenas, Ángel; Lanas Arbeloa, Ángel

    2015-07-14

    Esophageal cancer is one of the most unknown and deadliest cancers worldwide, mainly because of its extremely aggressive nature and poor survival rate. Esophageal cancer is the 6(th) leading cause of death from cancer and the 8(th) most common cancer in the world. The 5-year survival is around 15%-25%. There are clear differences between the risk factors of both histological types that affect their incidence and distribution worldwide. There are areas of high incidence of squamous cell carcinoma (some areas in China) that meet the requirements for cost-effectiveness of endoscopy for early diagnosis in the general population of those areas. In Europe and United States the predominant histologic subtype is adenocarcinoma. The role of early diagnosis of adenocarcinoma in Barrett's esophagus remains controversial. The differences in the therapeutic management of early esophageal carcinoma (high-grade dysplasia, T1a, T1b, N0) between different parts of the world may be explained by the number of cancers diagnosed at an early stage. In areas where the incidence is high (China and Japan among others) early diagnoses is more frequent and has led to the development of endoscopic techniques for definitive treatment that achieve very effective results with a minimum number of complications and preserving the functionality of the esophagus. PMID:26185366

  6. Medical management of iatrogenic esophageal perforations

    Microsoft Academic Search

    Ryan D. Madanick

    2008-01-01

    Opinion statement  Esophageal perforation is an uncommon, potentially disastrous occurrence with high mortality rates even when managed with\\u000a surgery. Over the past few decades, several case series have shown that nonoperative management is a feasible option in some\\u000a patients, although the criteria for selecting such patients are neither firmly established nor accepted by all those who manage\\u000a these critical patients. The

  7. Significance of feeding dysfunction in eosinophilic esophagitis

    PubMed Central

    Menard-Katcher, Calies; Henry, Michelle; Furuta, Glenn T; Atkins, Dan; Maune, Nancy Creskoff; Haas, Angela M

    2014-01-01

    Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis (EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth. PMID:25152606

  8. Ambulatory esophageal pH testing

    Microsoft Academic Search

    J. Patrick Shoenut; Clifford S. Yaffe

    1996-01-01

    Over a 30-month period, 867 esophageal pH studies were conducted in a Canadian teaching hospital; of these, 315 tests were recorded in patients who were first-time referrals having no chest or upper gastrointestinal surgery and taking no medication that would affect the results. Patients were referred by gastroenterologists, general surgeons, ENT surgeons, thoracic surgeons, and a miscellaneous group. Patients were

  9. Total Thoracic Esophagectomy for Esophageal Cancer

    Microsoft Academic Search

    Vladimir A Anikin; Kieran G McManus; Alastair N Graham; James A McGuigan

    1997-01-01

    Background: Many current methods of esophageal resection have drawbacks that result in inadequate proximal resection, inadequate lymphadenectomy, and difficult gastric and splenic access. We describe a technique that allows reliable and safe access to the chest, abdomen, and neck.Study Design: From 1988 to 1995, 113 patients (82 men; mean age 65.3 ± 4.5 years) with carcinoma of the esophagus or

  10. Esophageal squamous cell carcinoma: Pathology and prognosis

    Microsoft Academic Search

    Hiroko Ide; Tsutomu Nakamura; Kazuhiko Hayashi; Takeshi Endo; Ataru Kobayashi; Reiki Eguchi; Fujio Hanyu

    1994-01-01

    Between 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in

  11. Eosinophilic Esophagitis in Infants and Toddlers

    Microsoft Academic Search

    Scott P. Pentiuk; Claire Kane Miller; Ajay Kaul

    2007-01-01

    Feeding refusal is often described in conjunction with the diagnosis of eosinophilic esophagitis (EE) in pediatric patients;\\u000a however, there are little data regarding the specific clinical manifestations and effective management of this condition in\\u000a very young children. The aim of this study was to evaluate the presentation of EE in infants and toddlers referred to the\\u000a Interdisciplinary Feeding Team Clinic

  12. Radial distribution functions and densities for the SPC/E, TIP4P and TIP5P models for liquid water and ices Ih, Ic, II, III, IV, V,

    E-print Network

    McBride, Carl

    and ices Ih, Ic, II, III, IV, V, VI, VII, VIII, IX, XI and XIIw Carlos Vega,* Carl McBride, Eduardo Sanz from those of the other models, especially for ices Ih and II. For the higher density ices structural simulation studies have been undertaken for virtually all of the ice phases as well as for liquid water

  13. Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration

    SciTech Connect

    Dieleman, Edith [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Senan, Suresh [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)]. E-mail: s.senan@vumc.nl; Vincent, Andrew [Department of Bioinformatics, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Lagerwaard, Frank J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Slotman, Ben J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Soernsen de Koste, John R. van [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)

    2007-03-01

    Background: Chemo-radiotherapy for thoracic tumors can result in high-grade radiation esophagitis. Treatment planning to reduce esophageal irradiation requires organ motion to be accounted for. In this study, esophageal mobility was assessed using four-dimensional computed tomography (4DCT). Methods and Materials: Thoracic 4DCT scans were acquired on a 16-slice CT scanner in 29 patients. The outer esophageal wall was contoured in two extreme phases of respiration in 9 patients with nonesophageal malignancies. The displacement of the center of contour was measured at 2-cm intervals. In 20 additional patients with Stage I lung cancer, the esophagus was contoured in all 10 phases of each 4DCT at five defined anatomic levels. Both approaches were then applied to 4DCT scans of 4 patients who each had two repeat scans performed. A linear mixed effects model was constructed with fixed effects: measurement direction, measurement type, and measurement location along the cranio-caudal axis. Results: Measurement location and direction were significant descriptive parameters (Wald F-tests, p < 0.001), and the interaction term between the two was significant (p = 0.02). Medio-lateral mobility exceeded dorso-ventral mobility in the lower half of the esophagus but was of a similar magnitude in the upper half. Margins that would have incorporated all movement in medio-lateral and dorso-ventral directions were 5 mm proximally, 7 mm and 6 mm respectively in the mid-esophagus, and 9 mm and 8 mm respectively in the distal esophagus. Conclusions: The distal esophagus shows more mobility. Margins for mobility that can encompass all movement were derived for use in treatment planning, particularly for stereotactic radiotherapy.

  14. [Current status of nuclear medicine. Clinical application of FDG-PET for cancer diagnosis. Esophageal cancer].

    PubMed

    Noboru, Oriuchi

    2002-05-01

    Positron emission tomography (PET) with [18F]-fluorodeoxyglucose (FDG) is a tool for the imaging and evaluation of glucose metabolism. This technique has recently become available in more than thirty hospitals and has been approved under Japan's national health insurance program. FDG uptake correlates with glucose utilization in tissue and is widely used for evaluating malignant tumors as well as brain function and myocardial viability. FDG-PET is useful for the diagnosis of lung cancer, colon cancer, esophageal cancer, malignant lymphoma, malignant melanoma, head and neck cancer, myocardial viability, and epileptic focus. A brief summary of the application and utility of FDG-PET for esophageal carcinoma is described in this article. Because of its limited spatial resolution, FDG-PET is not able to evaluate the invasiveness of primary tumors and small lesions. However, the uptake of FDG correlates with the aggressiveness of the tumor and the prognosis of patients with esophageal carcinoma. The sensitivity, specificity, and accuracy of lymph node staging is higher than that with CT. FDG-PET has the advantage of being able to detect distant metastases on a single occasion. Evaluation of the response to therapy and of recurrence is also possible by means of FDG-PET. There is some normal uptake and physiological distribution of FDG in many organs. Physiological status has an effect on the uptake of FDG in normal organs, and, consequently, on lesion uptake. Understanding of these characteristics makes this procedure a useful diagnostic modality for the management of patients with esophageal carcinoma. PMID:12073632

  15. MicroRNAs and esophageal cancer--implications for pathogenesis and therapy.

    PubMed

    Mayne, George C; Hussey, Damian J; Watson, David I

    2013-01-01

    There are several microRNAs that have been consistently reported to be differentially expressed in esophageal squamous cell carcinoma vs. normal squamous tissue, with prognostic associations for miR-21 (invasion, positive nodes, decreased survival), miR-143 (disease recurrence, invasion depth), and miR-375 (inversely correlated with advanced stage, distant metastasis, poor overall survival, and disease-free survival). There is also evidence that miR-375 regulates gene expression associated with resistance to chemotherapy. Hence, microRNA expression assays have the potential to provide clinically relevant information about prognosis and potential response to chemotherapy in patients with esophageal squamous cell carcinoma. Results are inconsistent, however, for microRNAs across different studies for esophageal adenocarcinoma (EAC) vs. its precursor lesion Barrett's esophagus. These inconsistencies may partly result from pathological and/or molecular heterogeneity in both Barrett's esophagus and EAC, but may also result from differences in study designs or different choices of comparator tissues. Despite these inconsistencies, however, several mRNA/protein targets have been identified, the cancer related biology of some of these targets is well understood, and there are clinico-pathological associations for some of these mRNA targets. MicroRNAs also have potential for use in therapy for esophageal cancers. The development of new delivery methods, such as minicells and autologous microvesicles, and molecular modifications such as the addition of aromatic benzene pyridine analogs, have facilitated the exploration of the effects of therapeutic microRNAs in vivo. These approaches are producing encouraging results, with one technology in a phase I/IIa clinical trial. PMID:23092342

  16. Detection of Esophageal Squamous Cell Carcinoma by Cathepsin B Activity in Nude Mice

    PubMed Central

    Ma, Wei; Ma, Lie; Zhe, Hong; Bao, Cihang; Wang, Nana; Yang, Shaoqi; Wang, Kai; Cao, Fangli; Cheng, Yanna; Cheng, Yufeng

    2014-01-01

    Background and Objective Despite great progress in treatment, the prognosis for patients with esophageal squamous cell carcinoma (ESCC) remains poor, highlighting the importance of early detection. Although upper endoscopy can be used for the screening of esophagus, it has limited sensitivity for early stage disease. Thus, development of new diagnosis approach to improve diagnostic capabilities for early detection of ESCC is an important need. The aim of this study was to assess the feasibility of using cathepsin B (CB) as a novel imaging target for the detection of human ESCC by near-infrared optical imaging in nude mice. Methods Initially, we examined specimens from normal human esophageal tissue, intraepithelial neoplasia lesions, tumor in situ, ESCC and two cell lines including one human ESCC cell line (Eca-109) and one normal human esophageal epithelial cell line (HET-1A) for CB expression by immunohistochemistry and western blot, respectively. Next, the ability of a novel CB activatable near-infrared fluorescence (NIRF) probe detecting CB activity presented in Eca-109 cells was confirmed by immunocytochemistry. We also performed in vivo imaging of tumor bearing mice injected with the CB probe and ex vivo imaging of resected tumor xenografts and visceral organs using a living imaging system. Finally, the sources of fluorescence signals in tumor tissue and CB expression in visceral organs were identified by histology. Results CB was absent in normal human esophageal mucosa, but it was overexpressed in ESCC and its precursor lesions. The novel probe for CB activity specifically detected ESCC xenografts in vivo and in vitro. Conclusions CB was highly upregulated in human ESCC and its precursor lesions. The elevated CB expression in ESCC allowed in vivo and in vitro detection of ESCC xenografts in nude mice. Our results support the usefulness of CB activity as a potential imaging target for the detection of human ESCC. PMID:24618814

  17. Chromoendoscopy to Detect Early Synchronous Second Primary Esophageal Carcinoma in Patients with Squamous Cell Carcinomas of the Head and Neck?

    PubMed Central

    Komínek, Pavel; Vítek, Petr; Urban, Ond?ej; Zeleník, Karol; Halamka, Magdaléna; Feltl, David; Cvek, Jakub; Matoušek, Petr

    2013-01-01

    Objective. To evaluate the use of flexible esophagoscopy and chromoendoscopy with Lugol's solution in the detection of early esophageal carcinomas (second primary carcinomas) in patients with squamous cell carcinoma of the head and neck (HNSCC). Methods. All patients with newly diagnosed HNSCC underwent office-based Lugol's chromoendoscopy. After flexible esophagoscopy with white light, 3.0% Lugol's iodine solution was sprayed over the entire esophageal mucosa. Areas with less-intense staining (LVLs) were evaluated and biopsies taken. Results. 132 patients with HNSCC were enrolled in this study. The most frequent primary tumors were oropharyngeal (49/132), tumors of the oral cavity (36/132), and larynx (35/132). The majority of subjects (107/132 patients, 81.1%) had advanced HNSCC carcinomas (stages III and IV). Multiple LVLs were discovered in 24 subjects (18.2%) and no LVLs in 108 (81.8%) subjects. Fifty-five LVL biopsy specimens were obtained and assessed. Squamous cell carcinomas were detected in two patients, peptic esophagitis in 11 patients, gastric heterotopic mucosa in two patients, hyperplasia in two patients, and low- and high-grade dysplasia in three patients. Conclusion. Although only two patients with synchronous primary carcinomas were found among the patients, esophagoscopy should be recommended after detection of HNSCC to exclude secondary esophageal carcinoma or dysplasia. PMID:23573075

  18. Size analysis of lymph node metastasis in esophageal cancer: diameter distribution and assessment of accuracy of preoperative diagnosis

    Microsoft Academic Search

    Yoshiaki Kajiyama; Yoshimi Iwanuma; Natsumi Tomita; Takayuki Amano; Fuyumi Isayama; Toshiharu Matsumoto; Masahiko Tsurumaru

    2006-01-01

    Background  In esophageal cancer, lymphatic spread occurs more frequently and at an earlier stage than in other gastrointestinal cancers,\\u000a and both preoperative and intraoperative diagnoses of lymph nodes metastases are sometimes incorrect. Our objective was to\\u000a measure the sizes of lymphatic metastases and to examine the accuracy of clinical diagnosis of lymphatic spread in patients\\u000a with squamous cell carcinoma of the

  19. A phase I\\/II study of nedaplatin and 5-fluorouracil with concurrent radiotherapy in patients with esophageal cancer

    Microsoft Academic Search

    Yasushi Sato; Tetsuji Takayama; Tamotsu Sagawa; Tetsuro Okamoto; Koji Miyanishi; Tsutomu Sato; Hironobu Araki; Satoshi Iyama; Seiichiro Abe; Kazuyuki Murase; Rishu Takimoto; Hisayasu Nagakura; Masato Hareyama; Junji Kato; Yoshiro Niitsu

    2006-01-01

    Purpose: To determine the recommended dose (RD) of cis-diammine-glycolatoplatinum (nedaplatin) when given concurrently with 5-FU and high dose radiation therapy in the treatment of esophageal cancer. The purpose of the phase II trial is to determine efficacy and further define the side effect profile. Methods: Twenty-six patients with clinical stage I to IVA squamous cell carcinoma of the esophagus were

  20. Use of anti-inflammatory drugs and lower esophageal sphincter relaxing drugs and risk of esophageal and gastric cancers

    PubMed Central

    Fortuny, Joan; Johnson, Christine; Bohlke, Kari; Chow, Wong-Ho; Hart, Gene; Kucera, Gena; Mujumdar, Urvi; Ownby, Dennis; Wells, Karen; Yood, Marianne Ulcickas; Engel, Lawrence S.

    2007-01-01

    Background and aims The incidence of esophageal and gastric cardia adenocarcinoma has increased in western countries in recent decades for largely unknown reasons. We investigated whether use of lower esophageal sphincter (LES) relaxing drugs was related to an increased risk of esophageal and gastric cardia adenocarcinoma, and whether use of non-steroidal anti-inflammatory drugs was related to a reduced risk of esophageal and gastric cancers. Methods We examined these associations using administrative databases in a case-control study in two integrated health care delivery systems. Cases were incident esophageal adenocarcinomas (n= 163) and squamous cell carcinomas (n= 114), and gastric cardia (n= 176) and non-cardia adenocarcinomas (n= 320), diagnosed between 1980 and 2002 in one health system and between 1993 and 2002 in the other. Matched controls (n= 3996) were selected. Complete prescription information was available for the study period. Results Prescription of corticosteroids was associated with a decreased risk of esophageal adenocarcinoma (OR= 0.6, 95% CI= 0.4-0.9), esophageal squamous cell carcinoma (OR= 0.4, 95% CI= 0.2-0.6) and gastric non-cardia carcinoma (OR= 0.4, 95% CI=0.3-0.6). Ever use of pharmacy-purchased aspirin was associated with 30-60% decreased risks of the studied cancers. As a group, LES-relaxing drugs showed little evidence of association with increased risk of any esophageal or gastric cancer. Conclusions Corticosteroid and aspirin use were associated with significantly decreased risks of esophageal and gastric cancer. Lower esophageal sphincter relaxing drugs as a group did not affect these risks, although we had limited power to assess individual drugs. The possibility that corticosteroids and aspirin may reduce esophageal cancer risk warrants further consideration. PMID:17644046

  1. Initiation of esophageal squamous cell carcinoma (ESCC) in a murine 4-nitroquinoline-1-oxide and alcohol carcinogenesis model.

    PubMed

    Osei-Sarfo, Kwame; Urvalek, Alison M; Tang, Xiao-Han; Scognamiglio, Theresa; Gudas, Lorraine J

    2015-03-20

    Esophageal squamous cell carcinomas (ESCCs) are very common, aggressive tumors, and are often associated with alcohol and tobacco abuse. Because ESCCs exhibit high recurrence rates and are diagnosed at late stages, identification of prognostic and drug targets for prevention and treatment is critical. We used the 4-nitroquinoline-1-oxide (4-NQO) murine model of oral carcinogenesis and the Meadows-Cook model of alcohol abuse to assess changes in the expression of molecular markers during the initial stages of ESCC. Combining these two models, which mimic chronic alcohol and tobacco abuse in humans, we detected increased cellular proliferation (EGFR and Ki67 expression), increased canonical Wnt signaling and downstream elements (?-catenin, FoxM1, and S100a4 protein levels), changes in cellular adhesive properties (reduced E-cadherin in the basal layer of the esophageal epithelium), and increased levels of phosphorylated ERK1/2 and p38. Additionally, we found that treatment with ethanol alone increased the numbers of epithelial cells expressing solute carrier family 2 (facilitated glucose transporter, member 1) (SLC2A1) and carbonic anhydrase IX (CAIX), and increased the phosphorylation of p38. Thus, we identified both 4-NQO- and ethanol-specific targets in the initial stages of esophageal carcinogenesis, which should lead to the development of potential markers and therapeutic targets for human ESCC. PMID:25714027

  2. Initiation of esophageal squamous cell carcinoma (ESCC) in a murine 4-nitroquinoline-1-oxide and alcohol carcinogenesis model

    PubMed Central

    Osei-Sarfo, Kwame; Scognamiglio, Theresa; Gudas, Lorraine J.

    2015-01-01

    Esophageal squamous cell carcinomas (ESCCs) are very common, aggressive tumors, and are often associated with alcohol and tobacco abuse. Because ESCCs exhibit high recurrence rates and are diagnosed at late stages, identification of prognostic and drug targets for prevention and treatment is critical. We used the 4-nitroquinoline-1-oxide (4-NQO) murine model of oral carcinogenesis and the Meadows-Cook model of alcohol abuse to assess changes in the expression of molecular markers during the initial stages of ESCC. Combining these two models, which mimic chronic alcohol and tobacco abuse in humans, we detected increased cellular proliferation (EGFR and Ki67 expression), increased canonical Wnt signaling and downstream elements (?-catenin, FoxM1, and S100a4 protein levels), changes in cellular adhesive properties (reduced E-cadherin in the basal layer of the esophageal epithelium), and increased levels of phosphorylated ERK1/2 and p38. Additionally, we found that treatment with ethanol alone increased the numbers of epithelial cells expressing solute carrier family 2 (facilitated glucose transporter, member 1) (SLC2A1) and carbonic anhydrase IX (CAIX), and increased the phosphorylation of p38. Thus, we identified both 4-NQO- and ethanol-specific targets in the initial stages of esophageal carcinogenesis, which should lead to the development of potential markers and therapeutic targets for human ESCC. PMID:25714027

  3. Evolving Options in the Management of Esophageal Perforation

    Microsoft Academic Search

    Clayton J. Brinster; Sunil Singhal; Lawrence Lee; M. Blair Marshall; Larry R. Kaiser; John C. Kucharczuk

    2004-01-01

    Esophageal perforation remains a devastating event that is difficult to diagnose and manage. The majority of injuries are iatrogenic and the increasing use of endo- scopic procedures can be expected to lead to an even higher incidence of esophageal perforation in coming years. Accurate diagnosis and effective treatment depend on early recognition of clinical features and accurate interpretation of diagnostic

  4. Barrett's esophagus and esophageal adenocarcinoma: the scope of the problem

    Microsoft Academic Search

    M. S. Levine; J. B. Herman; E. E. Furth

    1995-01-01

    Conclusion  Barrett's esophagus is probably a more common condition than previously recognized. Although the classic radiologic findings of Barrett's esophagus are present in only a small percentage of patients, this condition should be suspected whenever reflux esophagitis or peptic strictures are demonstrated on double-contrast esophagography. Recent literature also suggests that Barrett's carcinomas comprise up to 50% of all esophageal cancers. Because

  5. Photodynamic Therapy for Barrett's Esophagus and Esophageal Carcinoma.

    PubMed

    Qumseya, Bashar J; David, Waseem; Wolfsen, Herbert C

    2013-01-01

    This paper reviews the use of photodynamic therapy (PDT) in patients with Barrett's esophagus and esophageal carcinoma. We describe the history of PDT, mechanics, photosensitizers for PDT in patients with esophageal disease. Finally, we discuss its utility and limitations in this setting. PMID:23423151

  6. Vitamin supplement use and risk for oral and esophageal cancer

    Microsoft Academic Search

    Jeanine Barone; Emanuela Taioli; James R. Hebert; Ernst L. Wynder

    1992-01-01

    In a hospital?based case?control study, 290 oral cancer cases and 133 esophageal cancer cases were queried as to smoking status, alcohol consumption, and dietary exposures, including vitamin supplement history. Among oral cancer cases, vitamin E use appeared to exert a protective effect. Vitamins C and E had protective effects among esophageal cancer cases. When stratified by smoking status, the protective

  7. Eosinophilic Esophagitis: Red on Microscopy, White on Endoscopy

    Microsoft Academic Search

    Alex Straumann; Hans-Peter Spichtin; Kathleen A. Bucher; Pius Heer; Hans-Uwe Simon

    2004-01-01

    Background\\/Aims: The presenting symptom of eosinophilic esophagitis, a chronic TH2-type inflammatory disease, is uniform dysphagia attacks. Histology reveals a dense mucosal infiltration with eosinophils. Unfortunately, endoscopic findings are often unremarkable or misleading. This study characterizes the endoscopic manifestations of eosinophilic esophagitis and analyzes the nature and clinical features of the frequently observed white alterations. Methods: Thirty adult patients (22 males,

  8. Clinical and Endoscopic Features of Eosinophilic Esophagitis in Adults

    Microsoft Academic Search

    John Croese; Stephen K. Fairley; John W. Masson; André K. H. Chong; David A. Whitaker; Peter A. Kanowski; Neal I. Walker

    2003-01-01

    BackgroundEosinophilic esophagitis in adults is regarded as unusual, being diagnosed mostly in young men presenting with dysphagia. Mucosal furrows are a sentinel endoscopic feature. This study examined the demographic and clinical profile of adults with eosinophilic esophagitis seen from 1981 to 2002.

  9. Proton pump inhibitor responsive esophageal eosinophilia, a distinct disease entity?

    PubMed Central

    Munday, William; Zhang, Xuchen

    2014-01-01

    Recent studies have suggested the existence of a patient population with esophageal eosinophilia that responds to proton pump inhibitor therapy. These patients are being referred to as having proton pump inhibitor responsive esophageal eosinophilia (PPI-REE), which is currently classified as a distinct and separate disease entity from both gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE). The therapeutic effect of proton pump inhibitor (PPI) on PPI-REE is thought to act directly at the level of the esophageal mucosa with an anti-inflammatory capacity, and completely independent of gastric acid suppression. The purpose of this manuscript is to review the mechanistic data of the proposed immune modulation/anti-inflammatory role of the PPI at the esophageal mucosa, and the existence of PPI-REE as a distinct disease entity from GERD and EoE. PMID:25132757

  10. Management of patients with combined tracheoesophageal fistula, esophageal atresia, and duodenal atresia

    PubMed Central

    Nabzdyk, Christoph S.; Chiu, Bill; Jackson, Carl-Christian; Chwals, Walter J.

    2014-01-01

    INTRODUCTION Patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia (DA) pose a rare management challenge. PRESENTATION OF CASE Three patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia safely underwent a staged approach inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week. None of the patients suffered significant pre- or post-operative complications and our follow-up data (between 12 and 24 months) suggest that all patients eventually outgrow their reflux and respiratory symptoms. DISCUSSION While some authors support repair of all defects in one surgery, we recommend a staged approach. A gastrostomy tube is placed first for gastric decompression before TEF ligation and EA repair can be safely undertaken. The repair of the DA can then be performed within 3–7 days under controlled circumstances. CONCLUSION A staged approach of inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week resulted in excellent outcomes. PMID:25460495

  11. Advanced esophageal cancer with tracheobronchial fistula successfully treated by?esophageal bypass surgery

    PubMed Central

    Kimura, Masahiro; Ishiguro, Hideyuki; Tanaka, Tatsuya; Takeyama, Hiromitsu

    2015-01-01

    Introduction When esophageal cancer infiltrates the respiratory tract and forms a fistula, a patient’s quality of life falls remarkably. Abstinence from oral feeding is necessary to prevent respiratory complications including pneumonia. Surgery is sometimes necessary to maintain quality of life. The aim of this study was to examine clinical outcomes of esophageal cancer complicated by tracheobronchial fistula. Presentation of case Twelve patients who underwent esophageal bypass between 2006 and 2011 in our hospital were studied. Patient characteristics, therapeutic course, outcome, and operation type were compared. Six patients among 8 who could not tolerate oral feeding could do so after bypass surgery. Ten patients were able to enjoy oral intake up until the last few days of life. Three patients survived for more than 10 months. In spite of undergoing an operation, 1 patient survived for only 2 months and another for 4 months. The only complication was postoperative delirium in 1 patient. Discussion While surgical bypass is more invasive than procedures such as endoscopic stenting, we had few complications after operative intervention and were able to maintain quality of life in our patients. Conclusion This bypass procedure is a treatment option for patients with tracheobronchial fistula from advanced esophageal cancer. PMID:25765740

  12. High Intraepithelial Eosinophil Counts in Esophageal Squamous Epithelium Are Not Specific for Eosinophilic Esophagitis in Adults

    Microsoft Academic Search

    Sonali Rodrigo; Gebran Abboud; Daniel Oh; Steven R. DeMeester; Jeffrey Hagen; John Lipham; Tom R. DeMeester; Parakrama Chandrasoma

    2008-01-01

    OBJECTIVESThe histologic criterion of >20 eosinophils per high power field (hpf) is presently believed to establish the diagnosis of idiopathic eosinophilic esophagitis (IEE). This is based on data that the number of intraepithelial eosinophils in gastroesophageal reflux disease (GERD) is less than 20\\/hpf. This study tests this belief.METHODSPathology records were searched for patients who had an eosinophil count >20\\/hpf in

  13. Reflux Esophagitis: Sequelae and Differential Diagnosis in Infants and Children Including Eosinophilic Esophagitis

    Microsoft Academic Search

    Beverly Barrett Dahms

    2004-01-01

    Gastroesophageal reflux disease (GERD) is a common condition in infants and children and has many clinical mimics. Most pediatric pathology departments process many mucosal biopsies from the proximal gastrointestinal tract to evaluate the presence or absence of reflux esophagitis. Since this subject was last reviewed in the 1997 edition of Perspectives in Pediatric Pathology devoted to gastrointestinal diseases in children

  14. Current endoscopic methods of radical therapy in early esophageal cancer

    PubMed Central

    Mocanu, A; Bârla, R; Hoara, P; Constantinoiu, S

    2015-01-01

    During the last three decades, there has been an increasing incidence of the esophageal cancer at the global level, approx. 400,000 new esophageal cancers being currently diagnosed annually. This is the eighth leading cause of cancer incidence and the sixth leading cause of cancer death overall. If we refer to the countries of Western Europe and North America, we could see an increase in the esophageal adenocarcinoma in detriment of squamous cancer. As for the Asian region, referring in particular to China and Japan, 9 out of 10 esophageal cancers are squamous cell carcinomas. Considering that the incidence of gastric cancer in Japan is very high, the endoscopic screenings performed inevitably led to an increased rate of early detection of esophageal cancer, reaching approximately 20% of all esophageal cancers detected. This has led to the possibility of developing therapeutic endoscopic techniques with radical visa that we will describe while presenting comparative data from literature. Currently, however, there are not enough data on the effectiveness of these types of therapies, compared to surgery, in order to be transformed into standard therapeutic endoscopic treatment for early esophageal cancer. However, the combined therapy, resection/ endoscopic ablation + chemoradiotherapy, appears as an alternative to be taken into account. Abbreviations EEC = esophageal early cancer, BE = Barrett’s esophagus, HGD = High-grade dysphagia, EUS = Ultra sound endoscopy, CT = Computer tomograph, UGE = Upper gastro endoscopy, PET-CT = Positron Emission Tomography, FNAB = Fine needle aspiration biopsy, EMR = Esophageal mucosal resection, ESD = Esophageal submucosal dissection, SCC = Squamous cellular cancer, PCT = Poli-chemotherapy, RT- Radio-therapy. PMID:25866570

  15. Circumferential intramural esophageal dissection successfully treated by endoscopic procedure and metal stent insertion

    Microsoft Academic Search

    Seong Hun Kim; Seung-Ok Lee

    2005-01-01

    Spontaneous intramural esophageal dissection is a rare disorder characterized by a lengthy laceration between the mucosal\\u000a and submucosal layers of the esophageal wall, without perforation. The majority of previously reported cases of spontaneous\\u000a intramural esophageal dissection were partial, and the circumferential type of intramural esophageal dissection has not been\\u000a reported previously. Most spontaneous intramural esophageal dissection responds to conservative management,

  16. High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone

    Microsoft Academic Search

    Nobuyuki Morikawa; Toshiro Honna; Tatsuo Kuroda; Koji Watanabe; Hideaki Tanaka; Hajime Takayasu; Akihiro Fujino; Hiroko Tanemura; Makoto Matsukubo

    2008-01-01

    One of the most serious problems in patients with long-gap esophageal atresia or corrosive esophagitis is esophageal stricture,\\u000a which may require esophageal resection and replacement. We describe two cases with persistent esophageal stricture successfully\\u000a managed by high dose intravenous methylprednisolone following balloon dilatation. High-dose methylprednisolone with gradual\\u000a tapering (daily 25, 15, 10, 5, 2 mg\\/kg for 4 days each) plus cimetidine and

  17. Emerging Therapeutic Options for Eosinophilic Esophagitis

    PubMed Central

    Dougherty, Timothy; Stephen, Sindu; Borum, Marie L.

    2014-01-01

    Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus that often occurs in atopic persons. Management strategies include pharmacotherapy, dietary modification, and endoscopic therapy, although patients will often have a relapsing and remitting course. Currently, the primary pharmacotherapy for EoE consists of corticosteroids. Immuno-modulators, leukotriene antagonists, biologies, and monoclonal antibodies are currently under study for treatment of EoE. The role of immunoglobulin E-mediated allergic reactions has been well documented and may provide insight into the etiology and effective therapy of EoE. PMID:24803874

  18. Cell sheets engineering for esophageal regenerative medicine

    PubMed Central

    Kanai, Nobuo; Yamato, Masayuki

    2014-01-01

    Recently, cell-based therapies, regenerative medicine, and tissue engineering have been progressing rapidly. We have developed a novel strategy for regenerative medicine to recover tissue functions using temperature-responsive cell culture surfaces. To overcome of conventional methods such as the usage of single-cell suspension injection, we have applied transplantable cell sheets fabricated with temperature-responsive culture surfaces for cell delivery. In the field of gastroenterology, transplantable cell sheets from autologous oral mucosal epithelial cells can prevent esophageal stricture following extensive endoscopic mucosal resection. PMID:25333004

  19. Esophageal hypomotility and spastic motor disorders: current diagnosis and treatment.

    PubMed

    Valdovinos, Miguel A; Zavala-Solares, Monica R; Coss-Adame, Enrique

    2014-11-01

    Esophageal hypomotility (EH) is characterized by abnormal esophageal peristalsis, either from a reduction or absence of contractions, whereas spastic motor disorders (SMD) are characterized by an increase in the vigor and/or propagation velocity of esophageal body contractions. Their pathophysiology is not clearly known. The reduced excitation of the smooth muscle contraction mediated by cholinergic neurons and the impairment of inhibitory ganglion neuronal function mediated by nitric oxide are likely mechanisms of the peristaltic abnormalities seen in EH and SMD, respectively. Dysphagia and chest pain are the most frequent clinical manifestations for both of these dysfunctions, and gastroesophageal reflux disease (GERD) is commonly associated with these motor disorders. The introduction of high-resolution manometry (HRM) and esophageal pressure topography (EPT) has significantly enhanced the ability to diagnose EH and SMD. Novel EPT metrics in particular the development of the Chicago Classification of esophageal motor disorders has enabled improved characterization of these abnormalities. The first step in the management of EH and SMD is to treat GERD, especially when esophageal testing shows pathologic reflux. Smooth muscle relaxants (nitrates, calcium channel blockers, 5-phosphodiesterase inhibitors) and pain modulators may be useful in the management of dysphagia or pain in SMD. Endoscopic Botox injection and pneumatic dilation are the second-line therapies. Extended myotomy of the esophageal body or peroral endoscopic myotomy (POEM) may be considered in highly selected cases but lack evidence. PMID:25376746

  20. Breast cancer resistance protein (BCRP) and excision repair cross complement-1 (ERCC1) expression in esophageal cancers and response to cisplatin and irinotecan based chemotherapy

    PubMed Central

    Bharthuar, Anubha; Black, Jennifer D.; Levea, Charles; Malhotra, Usha; Mashtare, Terry L.; Iyer, Renuka

    2014-01-01

    Background Esophageal cancer patients face a dismal outcome despite tri-modality management and median survival remains 15-18 months. Breast cancer resistance protein (BCRP) is an ATP-dependent efflux protein associated with chemotherapy resistance. The role of BCRP expression in esophageal cancer and normal esophageal cells is not known. Excision repair cross complement-1 (ERCC1) overexpression has been correlated with poorer response to cisplatin based chemotherapy. We examined the expression of BCRP and ERCC1 in patients with esophageal cancer and correlated it with survival in patients receiving irinotecan and cisplatin based chemotherapy. Methods With IRB approval, 40 cases of esophageal cancer diagnosed from 2004-2008, were stained for BCRP and ERCC1 expression by immunohistochemistry and scored by a pathologist blinded to clinical data. Baseline demographics, therapy given and survival data were collected and correlated with BCRP and ERCC1 expression. Fisher’s exact test was used to determine association between BCRP and ERCC1 expression and demographics. Cox proportional hazards model was used for association of BCRP and ERCC1 with survival. Results On immunohistochemistry, 30/40 cancers (75%) expressed BCRP. Interestingly, down-regulation of BCRP expression in tumor compared with normal cells was seen in 40% of patients. ERCC1 positivity was seen in 15/30 cases (50%). Median overall survival (OS) was 19 months with no difference in survival between BCRP positive and negative patients (P=0.13) or ERCC1 positive and negative patients (P=0.85). Estimated hazard ratio (HR) of death for BRCP positive patients was 2.29 (95% CI: 0.79-6.64) and for ERCC1 positive patients was 1.09 (95% CI: 0.46-2.56). There was no association of BCRP and ERCC1 expression with disease stage, age, gender or histology. For patients who received cisplatin and irinotecan as first line chemotherapy, there was no difference in survival based on BCRP or ERCC1 status. Conclusions BCRP expression is seen in a majority of esophageal cancers and normal esophageal mucosa. ERCC1 expression is seen in about half of the patients with esophageal cancer. Irinotecan based studies with esophageal and gastric cancer suggest response rates of 14-65%. Whether the 40% of tumors in our study found with down regulation of BCRP expression, constitute a majority of these responders needs to be prospectively validated in a larger data set. It should include markers such as ERCC1 predicting response to 5-fluorouracil and platinum based chemotherapy, to enable individualizing therapy for this cancer. PMID:25083297

  1. LG II balancer chromosomes in Caenorhabditis elegans: mT1(II;III) and the mIn1 set of dominantly and recessively marked inversions.

    PubMed

    Edgley, M L; Riddle, D L

    2001-11-01

    Two new genetic balancers for chromosome II of Caenorhabditis elegans were isolated and characterized. mIn1 was shown to be an inversion of a large central portion of the chromosome, extending from lin-31 to rol-1, that includes most of the genes on the chromosome. It balances a region to the left of the gene cluster that was previously not covered by any of the available balancers. mIn1 recombines efficiently with the normal chromosome II in regions outside the rearrangement at both ends, and appears to enhance recombination frequency adjacent to the inversion breakpoints. Eight variant strains of mIn1 were isolated, including forms that carry recessive morphological or lethal markers, an unmarked form, and one that carries an integrated transgene that confers a semi-dominant green fluorescent protein (GFP) phenotype. This set of variants makes mIn1 useful for a wide variety of applications. The second balancer, mT1, was shown to be a II;III translocation that suppresses recombination on the right arms of chromosomes II and III. It balances chromosome II from the region between bli-2 and dpy-10 to the right end of the chromosome, and chromosome III from the region between daf-2 and unc-93 to the right end. These rearrangements provide the means to stabilize efficiently most of the genes on chromosome II, and may be useful for studies of chromosome pairing and recombination. PMID:11713668

  2. Influence of chloride in mortar made of Portland cement types II, III, and V on the near-field microwave reflection properties

    NASA Astrophysics Data System (ADS)

    Hu, Cairong; Benally, Aaron D.; Case, Tobias; Zoughi, Reza; Kurtis, Kimberly

    2000-07-01

    Corrosion of steel rebar in reinforced concrete structures, can be induced by the presence of chloride in the structure. Corrosion of steel rebar is a problematic issue in the construction industry as it compromises the strength and integrity of the structure. Although techniques exist for chloride detection and its migration into a structure, they are destructive, time consuming and cannot be used for the interrogation of large surfaces. In this investigation three different portland cement types; namely, ASTM types II, III and V were used, and six cubic (8' X 8' X 8') mortar specimens were produced all with water-to-cement (w/c) ratio of 0.6 and sand-to-cement (s/c) ratio of 1.5. Tap water was used when producing three of these specimens (one of each cement type). For the other three specimens calcium chloride was added to the mixing tap water resulting in a salinity of 2.5%. These specimens were placed in a hydration room for one day and thereafter left it the room temperature with low humidity. The reflection properties of these specimens, using an open-ended rectangular waveguide probe, were monitored daily at 3 GHz (S-band) and 10 GHz (X-band). The results show the influence of cement type on the reflection coefficient as well as the influence of chloride on the curing process and setting time.

  3. alpha-Galactosidases II, III and IV from seeds of Trifolium repens. Purification, physicochemical properties and mode of galactomannan hydrolysis in vitro.

    PubMed Central

    Williams, J; Villarroya, H; Petek, F

    1978-01-01

    Five alpha-galactosidases (alpha-D-galactoside galactohydrolase, EC 3.2.1.22) were identified by chromatography and by their different electrophoretic mobilities, in the germinated seeds of Trifolium repens (white clover). alpha-Galactosidases II, III and IV were purified to homogeneity, with increases in specific activity of approx. 4600-, 4900- and 2800-fold respectively. The enzymes were purified by a procedure that included (NH4)2SO4 precipitation, hydroxyapatite, Sephadex G-75 and DEAE-cellulose chromatography, and preparative polyacrylamide-gel disc electrophoresis. The purified enzymes showed a single protein band, corresponding to the alpha-galactosidase activity, when examined by polyacrylamide-gel electrophoresis. The pH optimum was determined with o-nitrophenyl alpha-D-galactoside and the galactomannan of T. repens To as substrate. All three enzymes are highly thermolabile. Hydrolysis of oligosaccharides and galactomannans was examined, including two galactomannans from the germinated seed of T. repens (T24 and T36). By sodium dodecyl sulphate/polyacrylamide-gel electrophoresis the mol.wts. of the multiple forms of enzyme were found to be identical (41 000). PMID:33663

  4. Benign Esophageal Stricture in a Tropical African Population

    PubMed Central

    Ajao, Oluwole G.; Solanke, Toriola F.

    1978-01-01

    In North America, the most common causes of benign esophageal stricture are hiatal hernia and reflux esophagitis. These are localized to the lower end of the esophagus. At the University College Hospital, Ibadan, Nigeria, the most common cause of benign esophageal stricture is ingestion of corrosives. The ingestion is accidental, suicidal, or for medicinal purposes. This stricture is long, narrow, and irregular. Most extend from the cervical esophagus to the cardioesophageal junction. A surgical procedure that has given good results is the use of left colon pedicled on the left colic artery for retrosternal isoperistaltic esophagocoloplasty. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:702578

  5. Genetic landscape of esophageal squamous cell carcinoma.

    PubMed

    Gao, Yi-Bo; Chen, Zhao-Li; Li, Jia-Gen; Hu, Xue-Da; Shi, Xue-Jiao; Sun, Zeng-Miao; Zhang, Fan; Zhao, Zi-Ran; Li, Zi-Tong; Liu, Zi-Yuan; Zhao, Yu-Da; Sun, Jian; Zhou, Cheng-Cheng; Yao, Ran; Wang, Su-Ya; Wang, Pan; Sun, Nan; Zhang, Bai-Hua; Dong, Jing-Si; Yu, Yue; Luo, Mei; Feng, Xiao-Li; Shi, Su-Sheng; Zhou, Fang; Tan, Feng-Wei; Qiu, Bin; Li, Ning; Shao, Kang; Zhang, Li-Jian; Zhang, Lan-Jun; Xue, Qi; Gao, Shu-Geng; He, Jie

    2014-10-01

    Esophageal squamous cell carcinoma (ESCC) is one of the deadliest cancers. We performed exome sequencing on 113 tumor-normal pairs, yielding a mean of 82 non-silent mutations per tumor, and 8 cell lines. The mutational profile of ESCC closely resembles those of squamous cell carcinomas of other tissues but differs from that of esophageal adenocarcinoma. Genes involved in cell cycle and apoptosis regulation were mutated in 99% of cases by somatic alterations of TP53 (93%), CCND1 (33%), CDKN2A (20%), NFE2L2 (10%) and RB1 (9%). Histone modifier genes were frequently mutated, including KMT2D (also called MLL2; 19%), KMT2C (MLL3; 6%), KDM6A (7%), EP300 (10%) and CREBBP (6%). EP300 mutations were associated with poor survival. The Hippo and Notch pathways were dysregulated by mutations in FAT1, FAT2, FAT3 or FAT4 (27%) or AJUBA (JUB; 7%) and NOTCH1, NOTCH2 or NOTCH3 (22%) or FBXW7 (5%), respectively. These results define the mutational landscape of ESCC and highlight mutations in epigenetic modulators with prognostic and potentially therapeutic implications. PMID:25151357

  6. Association of p53 expression with prognosis in patients with esophageal squamous cell carcinoma

    PubMed Central

    Yao, Wenjian; Qin, Xiuguang; Qi, Bo; Lu, Jianguo; Guo, Ling; Liu, Fulei; Liu, Shangguo; Zhao, Baosheng

    2014-01-01

    It has been well accepted that p53 overexpression is associated with advanced stages of cancer. However, the prognostic role of p53 overexpression in esophageal squamous cell carcinoma (ESCC) remains unclear. To investigate the prognostic role of p53 overexpression in patients with ESCC, a retrospective cohort study of 136 ESCC patients was carried out. The expression of p53 protein in tumor tissues was investigated immunohistochemically. Positive expression of p53 protein was detected in 57 ESCC patients (41.9%). The p53 overexpression was associated with smoking (P < 0.001), tumor differentiation (P < 0.001), and tumor size (P < 0.001). In the Kaplan-Meier analysis, patients with p53 overexpression had significantly shorter overall survival than those patients with negative p53 expression (log-rank P < 0.001). Multivariable analysis by Cox regression model further showed that p53 overexpression was a significantly independent predictor of poorer overall survival (hazard ratio [HR] = 1.91; 95% confidence interval [95% CI] 1.03-3.54, P = 0.04). Thus, p53 overexpression is associated with poor prognosis in patients with early stage esophageal squamous cell carcinoma, and it’s a significantly independent predictor of poorer overall survival. PMID:25400812

  7. Cancer Staging

    MedlinePLUS

    ... over time. They continue to change as scientists learn more about cancer. Some staging systems cover many ... cancer treatment summaries that describe the staging of adult and childhood cancers. Information about cancer staging can ...

  8. [Esophageal diseases: gastroesophageal reflux disease, Barrett's esophagus, achalasia and eosinophilic esophagitis].

    PubMed

    Calvet, Xavier; Villoria, Albert

    2013-10-01

    Important new advances were presented in esophageal disease in Digestive Disease Week 2013. A highlight was confirmation of the high efficacy of weight loss to treat symptoms of reflux and an interesting pilot study suggesting that a simple ligature with supra- and infracardial bands could be an effective technique in esophageal reflux. If the excellent results and safety and efficacy of this technique are confirmed in the long term, it could revolutionize the management of gastroesophageal reflux disease. Also of note this year was the presentation of multiple studies validating a new technique, peroral endoscopic myotomy (POEM) for the endoscopic treatment of achalasia. This technique seems to have excellent efficacy and safety. PMID:24160952

  9. Berberine protects against esophageal mucosal damage in reflux esophagitis by suppressing proinflammatory cytokines

    PubMed Central

    CHOO, BYUNG KIL; ROH, SEONG-SOO

    2013-01-01

    This study was performed to investigate the effects of berberine (BB) in a rat model of gastroesophageal reflux disease (GERD), induced by pylorus and forestomach ligation. We evaluated cytotoxicity and proinflammatory biomarkers (nitric oxide, interleukin (IL)-1? and prostaglandin E2) in RAW 264.7 cells in vitro and anti-inflammatory effects in vivo. A total of 54 Sprague Dawley rats were divided into six groups: intact control rats; reflux esophagitis (RE) control rats; RE rats treated with 20 mg/kg omeprazole and RE rats treated with BB at doses of 20, 40 and 60 mg/kg, respectively. All rats were fasted. RE was induced by pylorus and forestomach ligation one hour subsequent to the oral treatment. Six hours subsequent to the surgery, the rats were sacrificed, blood was collected from the abdominal vein and the esophagus and stomach were dissected. The gastric volume and the pH of the gastric juice were evaluated, prior to the esophagus being cut longitudinally and an inner mucosal area being imaged, to analyze mucosal damage indices. Proinflammatory biomarkers in the serum, including tumor necrosis factor (TNF)-?, IL-1?, IL-6 and monocyte chemoattractant protein (MCP)-1 were analyzed using an enzyme-linked immunosorbent assay (ELISA) kit, while the mRNA expression of TNF-?, IL-1?, IL-6 and plasminogen activator inhibitor (PAI)-1 was analyzed using a quantitative polymerase chain reaction (qPCR). Esophagic tissue damage in the BB groups was dose-dependently decreased compared with that in the RE control group. This result was consistent with significant reductions in the levels of proinflammatory biomarkers in the serum and in the expression of proinflammatory mRNA, specifically, TNF-?, IL-1?, IL-6 and PAI-1. The results suggest that the anti-inflammatory and protective effects of BB may attenuate the severity of RE and prevent esophageal mucosal damage, in addition to validating the use of BB as a pharmacological treatment for esophageal reflux disease. PMID:24137243

  10. Multiple Rapid Swallow Responses During Esophageal High-Resolution Manometry Reflect Esophageal Body Peristaltic Reserve

    PubMed Central

    Shaker, Anisa; Stoikes, Nathaniel; Drapekin, Jesse; Kushnir, Vladimir; Brunt, L. Michael; Gyawali, C. Prakash

    2014-01-01

    OBJECTIVES Dysphagia may develop following antireflux surgery as a consequence of poor esophageal peristaltic reserve. We hypothesized that suboptimal contraction response following multiple rapid swallows (MRS) could be associated with chronic transit symptoms following antireflux surgery. METHODS Wet swallow and MRS responses on esophageal high-resolution manometry (HRM) were characterized collectively in the esophageal body (distal contractile integral (DCI)), and individually in each smooth muscle contraction segment (S2 and S3 amplitudes) in 63 patients undergoing antireflux surgery and in 18 healthy controls. Dysphagia was assessed using symptom questionnaires. The MRS/wet swallow ratios were calculated for S2 and S3 peak amplitudes and DCI. MRS responses were compared in patients with and without late postoperative dysphagia following antireflux surgery. RESULTS Augmentation of smooth muscle contraction (MRS/wet swallow ratios > 1.0) as measured collectively by DCI was seen in only 11.1% with late postoperative dysphagia, compared with 63.6% in those with no dysphagia and 78.1% in controls (P?0.02 for each comparison). Similar results were seen with S3 but not S2 peak amplitude ratios. Receiver operating characteristics identified a DCI MRS/wet swallow ratio threshold of 0.85 in segregating patients with late postoperative dysphagia from those with no postoperative dysphagia with a sensitivity of 0.67 and specificity of 0.64. CONCLUSIONS Lack of augmentation of smooth muscle contraction following MRS is associated with late postoperative dysphagia following antireflux surgery, suggesting that MRS responses could assess esophageal smooth muscle peristaltic reserve. Further research is warranted to determine if antireflux surgery needs to be tailored to the MRS response. PMID:24019081

  11. Bullous systemic lupus erythematosus associated with esophagitis dissecans superficialis.

    PubMed

    Yogarajah, Meera; Sivasambu, Bhradeev; Jaffe, Eric A

    2015-01-01

    Bullous systemic lupus erythematosus is one of the rare autoantibody mediated skin manifestation of systemic lupus erythematosus (SLE) demonstrating subepidermal blistering with neutrophilic infiltrate histologically. We present a case of a 40-year-old Hispanic female who presented with a several months' history of multiple blistering pruritic skin lesions involving the face and trunk, a photosensitive rash over the face and neck, swelling of the right neck lymph node, and joint pain involving her elbows and wrist. Her malady was diagnosed as bullous systemic lupus erythematosus based on the immunological workup and biopsy of her skin lesions. The patient also complained of odynophagia and endoscopy revealed esophagitis dissecans superficialis which is a rare endoscopic finding characterized by sloughing of the esophageal mucosa. The bullous disorders typically associated with esophagitis dissecans superficialis are pemphigus and rarely bullous pemphigoid. However, this is the first reported case of bullous systemic lupus erythematosus associated with esophagitis dissecans superficialis. PMID:25821624

  12. Bullous Systemic Lupus Erythematosus Associated with Esophagitis Dissecans Superficialis

    PubMed Central

    Jaffe, Eric A.

    2015-01-01

    Bullous systemic lupus erythematosus is one of the rare autoantibody mediated skin manifestation of systemic lupus erythematosus (SLE) demonstrating subepidermal blistering with neutrophilic infiltrate histologically. We present a case of a 40-year-old Hispanic female who presented with a several months' history of multiple blistering pruritic skin lesions involving the face and trunk, a photosensitive rash over the face and neck, swelling of the right neck lymph node, and joint pain involving her elbows and wrist. Her malady was diagnosed as bullous systemic lupus erythematosus based on the immunological workup and biopsy of her skin lesions. The patient also complained of odynophagia and endoscopy revealed esophagitis dissecans superficialis which is a rare endoscopic finding characterized by sloughing of the esophageal mucosa. The bullous disorders typically associated with esophagitis dissecans superficialis are pemphigus and rarely bullous pemphigoid. However, this is the first reported case of bullous systemic lupus erythematosus associated with esophagitis dissecans superficialis. PMID:25821624

  13. Esophageal involvement of pemphigus vulgaris associated with upper gastrointestinal bleeding.

    PubMed

    Chang, Sooyun; Park, Soo Jung; Kim, Sun Wook; Jin, Moo-Nyun; Lee, Jung-Hee; Kim, Hyun Ju; Hong, Sung Pil; Kim, Tae Il

    2014-09-01

    Esophageal involvement of pemphigus vulgaris is rare, and when present, the most common presenting symptoms reported in the medical literature are odynophagia and dysphagia. Here, we present two cases of pemphigus vulgaris presenting with upper gastrointestinal hemorrhage because of esophageal involvement of the disease. In case 1, a 41-year-old female patient with a prior diagnosis of pemphigus vulgaris presented with hematemesis. Esophagogastroduodenoscopy showed diffuse mucosal exfoliation and oozing bleeding of the oropharynx and esophagus. The patient recovered after the administration of high-dose corticosteroids and immunosuppressants. In case 2, a 30-year-old female patient with known pemphigus vulgaris also presented with hematemesis, showing similar endoscopic findings to the first case. She also responded to the same treatment. Esophageal involvement of pemphigus vulgaris responds to high-dose corticosteroids and immunosuppressants. Thus, in patients with pemphigus vulgaris with signs or symptoms of upper gastrointestinal bleeding, an early endoscopy for the evaluation of esophageal involvement is beneficial. PMID:25325007

  14. Esophageal cancer presenting as a brain metastasis: A case report

    PubMed Central

    SPALLONE, ALDO; IZZO, CHIARA

    2013-01-01

    Carcinoma of unknown primary origin (CUP) is defined as the histological diagnosis of metastasis without the detection of a primary tumor. The incidence of CUP in all patients with a malignant disease has been reported to be between 3 and 15%. Esophageal cancer is the third most common type of cancer of the digestive tract and the seventh most common cause of cancer-related mortality worldwide. The overall incidence of the disease is highest in males >50 years old. Brain metastases have been reported in only 1.7–3.6% of all patients with different types of esophageal cancer. Brain metastasis as the presenting form of esophageal carcinoma is highly uncommon. The present study reports the case of a patient with an unknown primary tumor who presented with a cerebral metastasis, without extra-neurological symptoms. The CUP was subsequently diagnosed as an esophageal carcinoma. PMID:24137398

  15. [Management of the esophageal candidiasis by the primary care physician].

    PubMed

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas

    2014-05-14

    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary. PMID:24930154

  16. High Orotate Phosphoribosyltransferase Gene Expression Predicts Complete Response to Chemoradiotherapy in Patients with Squamous Cell Carcinoma of the Esophagus

    Microsoft Academic Search

    Takeshi Kajiwara; Tomohiro Nishina; Ichinosuke Hyodo; Toshikazu Moriwaki; Shinji Endo; Junichirou Nasu; Shinichiro Hori; Bunzo Matsuura; Yoichi Hiasa; Morikazu Onji

    2009-01-01

    Objective: Chemoradiotherapy (CRT) is a possible alternative to surgery for esophageal cancer. As complete response (CR) to CRT is essential for a good prognosis, potential biomarkers predictive of CR were explored. Methods: Endoscopic tumor biopsies were obtained from 41 patients with stage II–III esophageal squamous cell carcinoma before 5-fluorouracil\\/cisplatin-based definitive CRT. cDNA was derived from RNA isolated from microdissected tumor

  17. Buspirone, a new drug for the management of patients with ineffective esophageal motility?

    PubMed

    Scheerens, Charlotte; Tack, Jan; Rommel, Nathalie

    2015-06-01

    Ineffective esophageal motility (IEM) is the most frequently encountered esophageal motility disorder. Patients may present with a variety of symptoms, such as dysphagia, heartburn, odynophagia, and regurgitation. Over the past years, the landscape of esophageal motility testing has been revolutionized; however, our current treatment options for IEM still remain limited. Previous studies have suggested that buspirone, a serotonin receptor agonist, enhances esophageal peristalsis and lower esophageal sphincter (LES) function. Recent work provides the first evidence that buspirone may influence LES resting pressure in patients with systemic sclerosis. Future research should evaluate whether the beneficial effects of buspirone also apply to the broad clinical entity of esophageal dysphagia patients with IEM. PMID:26137300

  18. Buspirone, a new drug for the management of patients with ineffective esophageal motility?

    PubMed Central

    Scheerens, Charlotte; Tack, Jan

    2015-01-01

    Ineffective esophageal motility (IEM) is the most frequently encountered esophageal motility disorder. Patients may present with a variety of symptoms, such as dysphagia, heartburn, odynophagia, and regurgitation. Over the past years, the landscape of esophageal motility testing has been revolutionized; however, our current treatment options for IEM still remain limited. Previous studies have suggested that buspirone, a serotonin receptor agonist, enhances esophageal peristalsis and lower esophageal sphincter (LES) function. Recent work provides the first evidence that buspirone may influence LES resting pressure in patients with systemic sclerosis. Future research should evaluate whether the beneficial effects of buspirone also apply to the broad clinical entity of esophageal dysphagia patients with IEM. PMID:26137300

  19. Neoadjuvant chemoradiotherapy for esophageal/gastroesophageal carcinoma

    PubMed Central

    Nurkin, Steven J.; Fong, Mei Ka; Groman, Adrienne; Flaherty, Leayn; Malhotra, Usha; LeVea, Charles M.; Yendamuri, Sai; Warren, Graham W.; Nava, Hector R.; May, Kilian S.

    2013-01-01

    Background Esophageal/gastroesophageal junction (GEJ) adenocarcinoma is increasingly treated with trimodality therapy. We present our experience using carboplatin/paclitaxel and radiotherapy followed by surgery. Methods Consecutive patients with distal esophageal/GEJ adenocarcinoma (?T2 or N+) treated from July 2010 to October 2011 were identified. Treatment included neoadjuvant carboplatin/paclitaxel with concurrent radiotherapy (CRT) to 50.4 Gy using an IMRT technique and then Ivor Lewis esophagogastrectomy (ILE). PET/CT was performed prior to and after CRT. Patient/treatment characteristics and tumor response were analyzed. Results Over this timeframe, 16 patients completed trimodality therapy. All were male, median age of 60 years (45-72 years). All tumors were grade 2-3 with mean tumor length of 4.4 cm (1-9 cm). A median of 6 cycles (5-9 cycles) neoadjuvant carboplatin/paclitaxel were administered. Average time from diagnosis to CRT completion was 76 days (44-141 days) and 60 days (35-92 days) from CRT end to surgery. Neoadjuvant CRT was well tolerated with mean weight loss of 3.9 kg. All pts had R0 resections. No anastomotic leaks or perioperative mortality occurred. Mean hospital stay was 13 days (8-28 days). Pathologic complete response (pCR) was seen in 38% of patients, microscopic residual disease (isolated tumor cells or <2 mm) in 31%, and macroscopic residual disease remained in 31%. Mean SUV reduction was 41% (0-100%). Of 11 patients with ?35% SUV decrease, 45% had pCR and 27% had microscopic residual disease. Three patients had signet ring features. Of these, 2 had no SUV reduction and all had gross residual disease, including the only patient with positive nodal disease. Conclusions Trimodality therapy utilizing concurrent carboplatin/paclitaxel and radiotherapy to 50.4 Gy followed by surgery was well tolerated and resulted in significant pathologic complete response or minimal residual disease. Further investigation of predictive factors for response is needed to best tailor therapy in the management of esophageal/GEJ adenocarcinoma. PMID:23730509

  20. Successful treatment with alectinib after crizotinib-induced esophageal ulceration.

    PubMed

    Yoneshima, Yasuto; Okamoto, Isamu; Takano, Tomotsugu; Enokizu, Aimi; Iwama, Eiji; Harada, Taishi; Takayama, Koichi; Nakanishi, Yoichi

    2015-06-01

    Crizotinib was the first clinically available inhibitor of the tyrosine kinase ALK, and next-generation ALK inhibitors, such as alectinib, are now under development. Although crizotinib is generally well tolerated, severe esophageal injury has been reported as a rare but serious adverse event of crizotinib therapy. We now describe the successful treatment with alectinib of a patient who developed crizotinib-induced esophageal ulceration. PMID:25837798

  1. Paraneoplastic cutaneous lupus secondary to esophageal squamous cell carcinoma.

    PubMed

    Koritala, Thoyaja; Tworek, Joseph; Schapiro, Brian; Zolotarevsky, Eugene

    2015-06-01

    Sporadic subacute cutaneous lupus erythematosus (SCLE) in an elderly man does not fit a typical demographic for the disease process. Using the McLean's criteria we were able to establish a temporal relationship between the patient's diagnosis of esophageal squamous cell carcinoma (SCC) and his dermatosis, both of which responded to cytotoxic chemotherapy. The clinical presentation and progression of the clinical illness is supportive of a very unusual and not previously reported paraneoplastic SCLE secondary to esophageal SCC. PMID:26029469

  2. Esophageal ruptures: triage using the systemic inflammatory response syndrome score

    Microsoft Academic Search

    Kouichi Furugaki; Junichi Yoshida; Koji Hokazono; Takuya Emoto; Jo Nakashima; Mayumi Ohyama; Toshiyuki Ishimitsu; Masahiro Shinohara; Kenichi Matsuo

    2011-01-01

    Esophageal rupture is a rare entity. Delay in the diagnosis and treatment may threaten the patient’s life. The decision for\\u000a surgical or nonsurgical treatment, however, remains controversial because advocates of both treatments have reported comparable\\u000a results. To quantify the decision making, we suggest the systemic inflammatory response syndrome (SIRS) score for triage of\\u000a an esophageal rupture. Using this criterion for

  3. Helicobacter pylori infection inhibits reflux esophagitis by inducing atrophic gastritis

    Microsoft Academic Search

    Tomoyuki Koike; Shuichi Ohara; Hitoshi Sekine; Katsunori Iijima; Katsuaki Kato; Tooru Shimosegawa; Takayoshi Toyota

    1999-01-01

    OBJECTIVE:Although it is widely accepted that Helicobacter pylori (H. pylori) infection is an important cause of atrophic gastritis, few studies have examined the relationship between H. pylori-induced atrophic gastritis and the occurrence of reflux esophagitis. The present study was aimed to examine the relationship between H. pylori infection, atrophic gastritis, and reflux esophagitis in Japan.METHODS:A total of 175 patients with

  4. Esophageal manometrics in patients with angina-like chest pain

    Microsoft Academic Search

    Douglas L. Brand; Doris Martin; Charles E. Pope

    1977-01-01

    Fifty-eight patients with angina-like chest pain had esophageal manometric testing. Forty-three had no evidence of coronary artery disease at the time of referral or at subsequent contact; 15 patients were proven to have coronary artery disease. High-amplitude contraction waves were the most frequently found manometric abnormality (15 patients). Less frequent were increased duration of contractions, achalasia, and diffuse esophageal spasm;

  5. Androgens and esophageal cancer: What do we know?

    PubMed Central

    Sukocheva, Olga A; Li, Bin; Due, Steven L; Hussey, Damian J; Watson, David I

    2015-01-01

    Significant disparities exist between genders for the development and progression of several gastro-intestinal (GI) diseases including cancer. Differences in incidence between men vs women for colon, gastric and hepatocellular cancers suggest a role for steroid sex hormones in regulation of GI carcinogenesis. Involvement of intrinsic gender-linked mechanisms is also possible for esophageal adenocarcinoma as its incidence is disproportionally high among men. However, the cause of the observed gender differences and the potential role of androgens in esophageal carcinogenesis remains unclear, even though the cancer-promoting role of androgen receptors (AR) shown in other cancers such as prostate and bladder suggests this aspect warrants exploration. Several studies have demonstrated expression of ARs in esophageal cancer. However, only one study has suggested a potential link between AR signaling and outcome - poorer prognosis. Two groups have analyzed data from cohorts with prostate cancer and one of these found a decreased incidence of esophageal squamous and adenocarcinoma after androgen deprivation therapy. However, very limited information is available about the effects of androgen and AR-initiated signaling on esophageal cancer cell growth in vitro and in vivo. Possible mechanisms for androgens/AR involvement in the regulation of esophageal cancer growth are considered, and the potential use of AR as a prognostic factor and clinical target is highlighted, although insufficient evidence is available to support clinical trials of novel therapies. As esophageal adenocarcinoma is a gender linked cancer with a large male predominance further studies are warranted to clarify the role of androgens and ARs in shaping intracellular signaling and genomic responses in esophageal cancer. PMID:26034350

  6. Beneficial Effects of Immediate Enteral Nutrition After Esophageal Cancer Surgery

    Microsoft Academic Search

    Satoshi Aiko; Yutaka Yoshizumi; Yoshiaki Sugiura; Tomokazu Matsuyama; Yoshihisa Naito; Junichi Matsuzaki; Tadaaki Maehara

    2001-01-01

    This study was conducted to determine the effects of immediate enteral nutrition (EN) on nutritional status, immunological\\u000a competence, and the suppression of excessive inflammatory responses in patients following esophageal cancer surgery. Twenty-four\\u000a patients who underwent the same elective operation for thoracic esophageal carcinoma were randomized into an immediate enteral\\u000a nutrition (IEN) group who received EN from postoperative day (POD) 1

  7. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures

    Microsoft Academic Search

    Rakesh Kochhar; Govind K. Makharia

    2002-01-01

    Introduction: The cornerstone treatment for benign esophageal strictures is endoscopic dilation. There are reports suggesting that intralesional corticosteroid injection decreases the frequency of endoscopic dilation. Methods: Seventy-one patients (mean age 42.39 [17.52] years; range, 13-78 years) with benign esophageal strictures (corrosive 29, peptic 14, anastomotic 19, radiation-induced 9) were recruited for this study. All were being managed with a program

  8. Variability in Diagnostic Criteria for Eosinophilic Esophagitis: A Systematic Review

    Microsoft Academic Search

    Evan S. Dellon; Ademola Aderoju; John T. Woosley; Robert S. Sandler; Nicholas J. Shaheen

    2007-01-01

    BACKGROUND:Eosinophilic esophagitis (EoE) is an emerging clinicopathologic entity defined by abnormal esophageal eosinophilic infiltration. Our understanding of this disease is hampered by the lack of a uniform diagnostic standard. The aim of this systematic review was to determine the range of diagnostic strategies and histologic criteria in the EoE literature.METHODS:The MEDLINE-indexed literature from 1950 through December 31, 2006 was independently

  9. Viewpoints on Acid-Induced Inflammatory Mediators in Esophageal Mucosa

    PubMed Central

    Harnett, Karen M; Rieder, Florian; Behar, Jose

    2010-01-01

    We have focused on understanding the onset of gastroesophageal reflux disease by examining the mucosal response to the presence of acid in the esophageal lumen. Upon exposure to HCl, inflammation of the esophagus begins with activation of the transient receptor potential channel vanilloid subfamily member-1 (TRPV1) in the mucosa, and production of IL-8, substance P (SP), calcitonin gene related peptide (CGRP) and platelet activating factor (PAF). Production of SP and CGRP, but not PAF, is abolished by the neural blocker tetrodotoxin suggesting that SP and CGRP are neurally released and that PAF arises from non neural pathways. Epithelial cells contain TRPV1 receptor mRNA and protein and respond to HCl and to the TRPV1 agonist capsaicin with production of PAF. PAF, SP and IL-8 act as chemokines, inducing migration of peripheral blood leukocytes. PAF and SP activate peripheral blood leukocytes inducing the production of H2O2. In circular muscle, PAF causes production of IL-6, and IL-6 causes production of additional H2O2, through activation of reduced nicotinamide adenine dinucleotide phosphate (NADPH) oxidases. Among these, NADPH oxidase 5 cDNA is significantly up-regulated by exposure to PAF; H2O2 content of esophageal and lower esophageal sphincter circular muscle is elevated in human esophagitis, causing dysfunction of esophageal circular muscle contraction and reduction in esophageal sphincter tone. Thus esophageal keratinocytes, that constitute the first barrier to the refluxate, may also serve as the initiating cell type in esophageal inflammation, secreting inflammatory mediators and pro-inflammatory cytokines and affecting leukocyte recruitment and activity. PMID:21103419

  10. Reconstruction techniques for hypopharyngeal and cervical esophageal carcinoma

    PubMed Central

    Jiang, Ming; He, Xiaotian; Wu, Duoguang; Han, Yuanyuan

    2015-01-01

    Objective To investigate the incidence of perioperative complications in patients with hypopharyngeal and cervical esophageal carcinoma who underwent three types of esophageal defect reconstruction procedures. Methods Clinical data from 105 patients with hypopharyngeal and cervical esophageal carcinoma who were treated at SUN YAT-SEN Memorial Hospital from January 2003 to February 2013 were retrospectively analyzed. Among these patients, 45 underwent a pectoral major muscle skin flap reconstruction following carcinoma resection (group A); 32 patients were treated with stomach replacement of the esophagus (group B), and 28 patients were treated with tube stomach replacement of the esophagus (group C). The incidences of perioperative complications were compared among these three groups. Results The incidences of anastomotic leakage, neck swelling, and incision infection were significantly lower in group C than in group A (P<0.05). The incidences of anastomotic leakage, reflux esophagitis, and thoracic stomach syndrome were significantly lower in group C than in group B (P<0.05). Conclusions Tube stomach replacement of the esophagus in the setting of hypopharyngeal and cervical esophageal carcinoma reduced the incidence of complications; therefore, it is a reasonable procedure for the management of esophageal defects. PMID:25922724

  11. Humoral response to catumaxomab correlates with clinical outcome: Results of the pivotal phase II/III study in patients with malignant ascites

    PubMed Central

    Ott, Marion G; Marmé, Frederik; Moldenhauer, Gerhard; Lindhofer, Horst; Hennig, Michael; Spannagl, Rolf; Essing, Mirko M; Linke, Rolf; Seimetz, Diane

    2012-01-01

    The trifunctional antibody catumaxomab is a targeted immunotherapy for the intraperitoneal treatment of malignant ascites. In a Phase II/III trial in cancer patients (n = 258) with malignant ascites, catumaxomab showed a clear clinical benefit vs. paracentesis and had an acceptable safety profile. Human antimouse antibodies (HAMAs), which could be associated with beneficial humoral effects and prolonged survival, may develop against catumaxomab as it is a mouse/rat antibody. This post hoc analysis investigated whether there was a correlation between the detection of HAMAs 8 days after the fourth catumaxomab infusion and clinical outcome. HAMA-positive and HAMA-negative patients in the catumaxomab group and patients in the control group were analyzed separately for all three clinical outcome measures (puncture-free survival, time to next puncture and overall survival) and compared to each other. There was a strong correlation between humoral response and clinical outcome: patients who developed HAMAs after catumaxomab showed significant improvement in all three clinical outcome measures vs. HAMA-negative patients. In the overall population in HAMA-positive vs. HAMA-negative patients, median puncture-free survival was 64 vs. 27 days (p < 0.0001; HR 0.330), median time to next therapeutic puncture was 104 vs. 46 days (p = 0.0002; HR 0.307) and median overall survival was 129 vs. 64 days (p = 0.0003; HR 0.433). Similar differences between HAMA-positive and HAMA-negative patients were seen in the ovarian, nonovarian and gastric cancer subgroups. In conclusion, HAMA development may be a biomarker for catumaxomab response and patients who developed HAMAs sooner derived greater benefit from catumaxomab treatment. PMID:21702044

  12. A phase II/III trial of bitopertin monotherapy compared with placebo in patients with an acute exacerbation of schizophrenia - results from the CandleLyte study.

    PubMed

    Bugarski-Kirola, D; Wang, A; Abi-Saab, D; Blättler, T

    2014-07-01

    Bitopertin is a glycine reuptake inhibitor postulated to improve N-methyl-d-aspartate receptor hypofunction by increasing synaptic glycine concentrations. This randomised, double-blind, placebo- and active-controlled phase II/III trial evaluated the efficacy and safety of bitopertin monotherapy over 4 weeks in patients with acute exacerbation of schizophrenia. Of 301 patients randomised, 299 received placebo (n=80), bitopertin 10mg (n=80) or 30mg (n=77), or olanzapine 15mg (n=62). The primary endpoint, change from baseline in mean Positive and Negative Syndrome Scale (PANSS) total score, showed non-statistically significant improvements with bitopertin 30mg and olanzapine vs. placebo: bitopertin 10mg (-11.7; standard error [SE], 1.89; p=0.945), bitopertin 30mg (-15.3; SE, 1.87; p=0.211), olanzapine (-14.9; SE, 2.13; p=0.295) and placebo (-11.9; SE, 1.90). The PANSS positive subscale score, a secondary endpoint, also showed improvement with bitopertin 30mg (p=0.030) whereas a trend was observed with olanzapine (p=0.072) vs. placebo. Although not statistically significant, bitopertin 30mg and olanzapine reduced overall illness severity (Clinical Global Impression-Severity Scale; p=0.098 and p=0.126, respectively). More patients receiving bitopertin 30mg (51.3%) or olanzapine (52.5%) than placebo (32.9%) were ready for hospital discharge at Week 4 (bitopertin, p=0.014; olanzapine, p=0.024). In summary, this study failed due to lack of statistical separation of either bitopertin or olanzapine (active control) from placebo on the primary endpoint. Of interest, improved positive symptoms and readiness for hospital discharge were associated with both bitopertin and olanzapine treatment. Bitopertin was safe and well tolerated in this study. PMID:24735806

  13. Manganese(II,III) Oxyborate, Mn 2OBO 3: A Distorted Homometallic Warwickite—Synthesis, Crystal Structure, Band Calculations, and Magnetic Susceptibility

    NASA Astrophysics Data System (ADS)

    Norrestam, R.; Kritikos, M.; Sjödin, A.

    1995-02-01

    The manganese(II,III) oxyborate with the composition Mn 2OBO 3 has been synthesized by high-temperature techniques. X-ray studies show that crystals of the specimen, grown with borax as flux, are monoclinic, with space group P2 1/ n, = 9.2866(7), b = 9.5333(10), c = 3.2438(3) Å, and ? = 90.757(7)°. A model of the crystal structure has been refined with the 2064 most significant ( l ? 5 · ? 1) X-ray reflections with sin(?)/? ? 1.08 Å -1 to R = 0.40. The structure of Mn 2OBO 3 can be considered to be a distorted modification of the orthorhombic warwickite structure. The distortions, apparently caused by Jahn-Teller effects induced by the Mn 3+ ions, remove the mirror symmetry of the parent undistorted warwickite. As a consequence, the space group symmetry is lowered from Pnam to one of its subgroups, P2 1/ n. The structural results as well as the measured magnetic susceptibilities indicate high-spin manganese ions. The magnetic susceptibilities in the temperature region 110-300 K follow the Curie-Weiss law. The Weiss constant of -132(1) K indicates an antiferromagnetic ordering at low temperature. The bond distances and calculated bond valence sums indicate that the trivalent manganese ions are located in the two inner columns of the four-octahedra-wide walls. This metal charge distribution is supported by extended Hückel band calculations on some homometallic warwickites. The difference in metal coordination around one of the borate oxygen atoms is reflected by a significant deviation of the borate group geometry from the ideal trigonal symmetry.

  14. Gastro-esophageal Reflux Disease (GERD)

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program discusses Gastro-Esophageal Reflux Disease, or GERD, including the anatomy of the digestive system, causes and effects, signs and symptoms, possible complications, and treatment options for GERD with their benefits and side effects. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  15. Prediction of outcome with FDG-PET in definitive chemoradiotherapy for esophageal cancer

    PubMed Central

    Atsumi, Kazushige; Nakamura, Katsumasa; Abe, Koichiro; Hirakawa, Masakazu; Shioyama, Yoshiyuki; Sasaki, Tomonari; Baba, Shingo; Isoda, Takuro; Ohga, Saiji; Yoshitake, Tadamasa; Shinoto, Makoto; Asai, Kaori; Honda, Hiroshi

    2013-01-01

    The purpose of this study was to assess the efficacy of 18F-fluoro-2-deoxy-glucose uptake positron emission tomography (FDG-PET) for the prediction of outcome in definitive chemoradiotherapy (CRT) for esophageal cancer. We enrolled 56 patients with esophageal cancer treated with definitive CRT and examined by FDG-PET before treatment. We examined the correlation of the maximum standardized uptake value (SUVmax) in FDG-PET of the primary tumor with overall survival (OS), progression-free survival (PFS), local control (LC) and response of the primary tumor. After definitive CRT, 30 patients had a clinical complete response (CR), making the CR rate 54%. For all 56 patients, the 2-year OS rate, PFS rate and LC rates were 64%, 38% and 51%, respectively. We divided the patients into two groups according to SUVmax: SUVmax < 10 (low-SUV) and ?10 (high-SUV). The 2-year OS rates in the low- and high-SUV groups were 100% and 41%, the PFS rates were 73% and 19%, the LC rates were 71% and 39%, and the CR rates were 100% and 32%, respectively. A univariate analysis revealed significant differences between the low- and high-SUV group in OS, PFS, LC and response (P = 0.0005, 0.0002, 0.048, and <0.0001, respectively). SUVmax and T stage were significantly associated with OS, PFS, LC and response. A multivariate analysis showed significant differences between the SUVmax <10 and ?10 groups in overall survival and response (P < 0.05). Our result suggests that the SUVmax in FDG-PET of the primary tumor before treatment may have prognostic value for esophageal cancer. PMID:23520267

  16. Overexpression of WRAP53 Is Associated with Development and Progression of Esophageal Squamous Cell Carcinoma

    PubMed Central

    Rao, Xuguang; Huang, Daofu; Sui, Xuxia; Liu, Gefei; Song, Xuhong; Xie, Jinglian; Huang, Dongyang

    2014-01-01

    Background Esophageal squamous cell carcinoma (ESCC) is a highly aggressive cancer whose underlying molecular mechanisms are poorly understood. The natural antisense transcript (NAT) WRAP53 regulates p53 expression and WRAP53 protein is a component of telomerase. NATs play key roles in carcinogenesis, and although WRAP53 is known to increase cancer cell survival, its role in ESCC clinicopathology is unknown. The aim of this study was to investigate WRAP53 expression in ESCC and to correlate it with clinicopathological characteristics. Methods WRAP53 mRNA and protein expression was measured by quantitative PCR (qRT-PCR) and western blotting, respectively, in 4 ESSC cells lines and in 45 paired ESCC and non-neoplastic esophageal mucosa tissues. To correlate WRAP53 protein expression with clinicopathological characteristics, immunohistochemistry (IHC) was performed on 134 ESCC and 85 non-neoplastic esophageal mucosa tissues. Results Expression of WRAP53 was detected in all ESCC cell lines and was upregulated in the ESCC tissues compared with the corresponding non-neoplastic tissues (P<0.01). More cells expressed WRAP53 protein in the ESCC tissues than in the non-neoplastic tissues (P<0.01). Overexpression of WRAP53 was significantly correlated with tumor infiltration depth (P?=?0.000), clinical stage (P?=?0.001), and lymph node metastasis (P?=?0.025). Wrap53 expression was not correlated with age, gender, or tumor differentiation. Conclusion This report indicates increased expression of WRAP53 in ESCC and that WRAP53 overexpression is correlated with tumor progression. WRAP53 may play a significant role in ESCC; accordingly, WRAP53 could be a useful biomarker for ESCC. PMID:24626331

  17. Comparison of core decompression and conservative treatment for avascular necrosis of femoral head at early stage: a meta-analysis

    PubMed Central

    Hong, Yu-Cai; Zhong, Hui-Ming; Lin, Tiao; Shi, Jian-Bin

    2015-01-01

    The purpose of the current meta-analysis was to compare the efficacy of core decompression (CD) and conservative treatment (CT) for saving femoral heads in patients with avascular necrosis of femoral head (ANFH). Four RCTs and two CCTs involving 323 hips with 24- to 48-months follow-up were included in this review. Our results suggested CD had a trend of favorable results in contrast to other CT (OR 3.28; 95% CI 0.77-14.02; P = 0.11) but saved much less hips compared to biophysical treatments [odds ratio (OR) 0.37; 95% CI 0.18-0.74; P = 0.005]. In the stratified survival rate analysis by ANFH stage, interestingly, CD group got a significantly higher successful rate of hip joint conservation than other CT group in both stage I and stage II-III (stage I: OR 4.43; 95% CI 1.34-14.65; P = 0.01; stage II-III: OR 6.75; 95% CI 2.18-20.90; P = 0.0009). In the biophysical stimulation subgroup, however, an even higher frequency of survived hips were observed compared to CD group at stage II-III (CD vs. biophysical stimulation: OR 0.34; 95% CI 0.17-0.67; P = 0.002). In conclusion, performing CD for ANFH is effective for preventing femoral collapse within a short-term follow-up, but an even higher successful rate were expected by biophysical stimulations. Nevertheless, the short-term follow-up, the small sample size of the current meta-analysis only provide limited quality of evidence, which required confirmation from further large-scale, well-designed RCT with longer follow-up.

  18. Quantitative real-time RT-PCR validation of differential mRNA expression of SPARC, FADD, Fascin, COL7A1, CK4, TGM3, ECM1, PPL and EVPL in esophageal squamous cell carcinoma

    Microsoft Academic Search

    Nan Hu; Luxia Qian; Ying Hu; Jian-Zhong Shou; Chaoyu Wang; Carol Giffen; Quan-Hong Wang; Yuan Wang; Alisa M Goldstein; Michael Emmert-Buck; Philip R Taylor

    2006-01-01

    BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is one of the most malignant tumors and typically presents at an advanced and rapidly fatal stage. To better understand the role of genetics in the etiology and prevention of ESCC and to identify potential susceptibility genes as well as early detection markers, we previously compared tumor and matched normal tissues from ESCC patients

  19. Clinical esophageal pH recording: A technical review for practice guideline development

    Microsoft Academic Search

    Peter J Kahrilas; Eamonn M. M Quigley

    1996-01-01

    Our present concept of peptic esophagitis dates back to 1935, when Winkelstein suggested that gastric secretions were the cause of mucosal damage observed in peptic esophagitis.1GASTROENTEROLOGY 1996;110-1982-1996

  20. MMP-2 and DcR3 expression in esophageal cancer tissue and correlation with patient survival

    PubMed Central

    Ao, Ran; Du, Ya-Qi; Wang, Ying; Chen, Yu-Shuai; Wang, Bing-Yuan

    2013-01-01

    Objective: This study aims to explore the expression of decoy receptor 3 (DcR3) and the matrix metalloproteinase-2 (MMP-2) in esophageal carcinoma and their relationship with patient survival. Methods: The EnVisionTM immunohistochemistry method was used to examine DcR3 and MMP-2 expression in 150 surgical biopsies of esophageal carcinoma. Expression level was compared with clinical indices and with patient survival. Results: In cancer tissues, the positive expression rate of DcR3 and MMP-2 was 54.00% and 54.67% respectively; this was higher than levels in adjacent normal tissue. DcR3 and MMP-2 were positively correlated with carcinoma size, lymphatic metastasis, invasion degree, clinical stage and 3-year survival. DcR3 and MMP-2 were not correlated with gender, age and tumor degree of differentiation. DcR3 and MMP-2 were positively correlated between in the two groups (r = 0.37, P < 0.01). Kaplan-Meier survival curve showed that higher rates of DcR3 and MMP-2 expression correlated with lower survival. Conclusions: Determining DcR3 and MMP-2 expression may be useful for the diagnosis, treatment and prognosis of patients with esophageal carcinoma. PMID:24040480

  1. TGM2 A Cell Surface Marker in Esophageal Adenocarcinomas

    PubMed Central

    Leicht, Deborah T.; Kausar, Tasneem; Wang, Zhuwen; Ferrer-Torres, Daysha; Wang, Thomas D.; Thomas, Dafydd G.; Lin, Jules; Chang, Andrew C.; Lin, Lin; Beer, David G.

    2014-01-01

    Introduction Esophageal adenocarcinomas (EAC) are aggressive cancers that are increasing in incidence and associated with a poor prognosis. The identification of highly expressed genes in EAC relative to metaplastic Barrett’s esophagus (BE) may provide new targets for novel early cancer detection strategies using endoscopically administered, fluorescently labeled peptides. Methods Gene expression analysis of BE and EACs were used to identify the cell surface marker transglutaminase 2 (TGM2) as overexpressed in cancer. The expression of two major isoforms of TGM2 was determined by qRT-polymerase chain reaction in an independent cohort of 128 EACs. Protein expression was confirmed by tissue microarrays and immunoblot analysis of EAC cell lines. TGM2 DNA copy number was assessed using single nucleotide polymorphism microarrays and confirmed by qPCR. TGM2 expression in neoadjuvantly treated EACs and following small interfering RNA-mediated knockdown in cisplatin-treated EAC cells was used to determine its possible role in chemoresistance. Results TGM2 is overexpressed in 15 EACs relative to 26 BE samples. Overexpression of both TGM2 isoforms was confirmed in 128 EACs and associated with higher tumor stage, poor differentiation, and increased inflammatory and desmoplastic response. Tissue microarrays and immunohistochemistry confirmed elevated TGM2 protein expression in EAC. Single nucleotide polymorphism and qPCR analysis revealed increased TGM2 gene copy number as one mechanism underlying elevated TGM2 expression. TGM2 was highly expressed in resistant EAC after patient treatment with neoadjuvant chemotherapy/radiation suggesting a role for TGM2 in chemoresistance. Conclusion TGM2 may be a useful cell surface biomarker for early detection of EAC. PMID:24828664

  2. Late Toxicity After Definitive Concurrent Chemoradiotherapy for Thoracic Esophageal Carcinoma

    SciTech Connect

    Morota, Madoka [Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan)], E-mail: madoka.kumada@jfcr.or.jp; Gomi, Kotaro [Department of Radiation Oncology, Suwa Red Cross Hospital, Nagano (Japan); Kozuka, Takuyo [Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan); Chin, Keisho [Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan); Matsuura, Masaaki [Department of Cancer Genomics, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan); Ito, Hisao [Department of Radiology, Graduate School of Medicine, Chiba University, Chiba (Japan); Yamashita, Takashi [Department of Radiation Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (Japan)

    2009-09-01

    Purpose: To evaluate late cardiopulmonary toxicities after concurrent chemoradiotherapy (CCRT) for esophageal carcinomas. Methods and Materials: From February 2002 through April 2005, 74 patients with clinical Stage I-IVB carcinoma of the esophagus were treated with CCRT. Sixty-nine patients with thoracic squamous cell carcinoma were the core of this analysis. Patients received 60 Gy of radiation therapy in 30 fractions over 8 weeks, including a 2-week break, and received 2 cycles of fluorouracil/cisplatin chemotherapy concomitantly. Initial radiation fields included primary tumors, metastatic lymph nodes, and supraclavicular, mediastinal, and celiac nodes areas. Late toxicities were assessed with the late radiation morbidity scoring scheme of the Radiation Therapy Oncology Group/European Organiation for Research and Treatment of Cancer. Results: The median age was 67 years (range, 45-83 years). The median follow-up time was 26.1 months for all patients and 51.4 months for patients still alive at the time of analysis. Five cardiopulmonary toxic events of Grade 3 or greater were observed in 4 patients, Grade 5 heart failure and Grade 3 pericarditis in 1 patient, and Grade 3 myocardial infarction, Grade 3 radiation pneumonitis, and Grade 3 pleural effusion. The 2-year cumulative incidence of late cardiopulmonary toxicities of Grade 3 or greater for patients 75 years or older was 29% compared with 3% for younger patients (p = 0.005). Conclusion: The CCRT used in this study with an extensive radiation field is acceptable for younger patients but is not tolerated by patients older than 75 years.

  3. The Function and Interaction of Genes Related to Esophageal Squamous Cell Cancer

    Microsoft Academic Search

    Yu Long Chen; Su Gai Yin; Yao Song Wu

    2011-01-01

    Objective: To study the function and interaction of genes related to esophageal squamous cell cancer and discuss esophageal cancer molecular mechanism.Methods: The gene microarray date set of esophageal was downloaded from the GEO BRB-ArrayTools and online tool was used to analysis the difference expression genes between esophageal squamous cell cancer and normal tissue, and analysis the functional and interaction of

  4. Does Dysphagia Indicate Recurrence of Benign Esophageal Strictures?

    PubMed Central

    Borgström, Anders; Fork, Frans-Thomas; Lövdahl, Eje

    1995-01-01

    Esophageal dilatation in dysphagic patients with benign strictures is usually considered successful if the patients' dysphagia is alleviated. However, the relation between dysphagia and the diameter of a stricture is not well understood. Moreover, the dysphagia may also be caused by an underlying esophageal motor disorder. In order to compare symptoms and objective measurements of esophageal stricture, 28 patients were studied with interview and a radiologic esophagram. The latter included swallowing of a solid bolus. All patients underwent successful balloon dilatation at least one month prior to this study. Recurrence of a stricture with a diameter of less than 13 mm was diagnosed by the barium swallow in 21 patients. Recurrence of dysphagia was seen in 15 patients. Thirteen patients denied any swallowing symptoms. Chest pain was present in 9 patients. Of 15 patients with dysphagia 2 (13%) had no narrowing but severe esophageal dysmotility. Of 13 patients without dysphagia 9 (69%) had a stricture with a diameter of 13 mm or less. Of 21 patients with a stricture of 13 mm or less 14 (67%) were symptomatic while 7 (33%) were asymptomatic. Four of 11 patients with retrosternal pain had a stricture of less than 10 mm. Three patients with retrosternal pain and obstruction had severe esophageal dysmotility. Whether or not the patients have dysphagia may be more related to diet and eating habits than to the true diameter of their esophageal narrowing. We conclude that the clinical history is non-reliable for evaluating the results of esophageal stricture dilatation. In order to get an objective measurement of therapeutic outcome, barium swallow including a solid bolus is recommended. PMID:18493375

  5. A three-protein signature and clinical outcome in esophageal squamous cell carcinoma

    PubMed Central

    Wu, Zhi-Yong; Wu, Jian-Yi; Wang, Shao-Hong; Li, En-Min; Xu, Li-Yan

    2015-01-01

    Current staging is inadequate to precisely predict clinical outcome of esophageal squamous cell carcinoma (ESCC) and determine treatment choices, which vary from operation alone to intensive multimodal regimens. The purpose of this study is to investigate the prognostic values of an immunohistochemistry-based three-protein signature model in patients with ESCC. We determined the protein expression of Annexin II, cofilin 1, ezrin, fascin, kindlin-2, moesin, MTSS1, myosin-9, profilin-1, Rac1, radixin, ROCK2, talin, tensin and villin 1 in a test cohort including 110 formalin-fixed, paraffin-embedded esophageal curative resection specimens by tissue microarrays (TMAs). A three-protein signature elicited from the protein cluster, Annexin II, kindlin-2, and myosin-9, was validated by TMAs on an independent cohort of 147 specimens. The expression of three-protein signature was highly predictive of ESCC overall survival (OS) and disease-free survival (DFS) in both generation and validation datasets. Regression analysis shows that this three-protein signature is an independent predictor for OS and DFS. Furthermore, the predictive ability of these 3 biomarkers in combination is more robust than that of each individual biomarker. This study demonstrates a clinically applicable prognostic model that accurately predicts ESCC patient survival and/or tumor recurrence, and thus could serve as a complement to current risk stratification approaches. PMID:25605255

  6. Useful strategies to prevent severe stricture after endoscopic submucosal dissection for superficial esophageal neoplasm

    PubMed Central

    Uno, Kaname; Iijima, Katsunori; Koike, Tomoyuki; Shimosegawa, Tooru

    2015-01-01

    The minimal invasiveness of endoscopic submucosal dissection (ESD) prompted us to apply this technique to large-size early esophageal squamous cell carcinoma and Barrett’s adenocarcinoma, despite the limitations in the study population and surveillance duration. A post-ESD ulceration of greater than three-fourths of esophageal circumference was advocated as an important risk factor for refractory strictures that require several sessions of dilation therapy. Most of the preoperative conditions are asymptomatic, but dilatation treatment for dysphagia associated with the stricture has potential risks of severe complications and a worsening of quality of life. Possible mechanisms of dysphasia were demonstrated based on dysmotility and pathological abnormalities at the site: (1) delayed mucosal healing; (2) severe inflammation and disorganized fibrosis with abundant extracellular matrices in the submucosa; and (3) atrophy in the muscularis proper. However, reports on the administration of anti-scarring agents, preventive dilation therapies, and regenerative medicine demonstrated limited success in stricture prevention, and there were discrepancies in the study designs and protocols of these reports. The development and consequent long-term assessments of new prophylactic technologies on the promotion of wound healing and control of the inflammatory/tumor microenvironment will require collaboration among various research fields because of the limited accuracy of preoperative staging and high-risk of local recurrence.

  7. High expression of TACC3 in esophageal squamous cell carcinoma correlates with poor prognosis

    PubMed Central

    Xiao, Yi-Ren; Cao, Xun; Zhu, Lin-Chun; Zeng, Mu-Sheng; Zhong, Qian; Wen, Zhe-Sheng

    2015-01-01

    To analyze the expression of the transforming acidic coiled-coil protein 3 (TACC3) in esophageal squamous cell carcinoma (ESCC) samples, and to identify whether TACC3 can serve as a biomarker for the diagnosis and prognosis of ESCC, qPCR, western blotting and immunohistochemistry staining (IHC) were utilized to detect the expression of TACC3. Furthermore, cell growth, colony formation, migration ability and the epithelial-mesenchymal transition markers of ESCC cells in which TACC3 were knocked-down were measured. The mRNA and protein levels of TACC3 were higher in ESCC specimens compared to non-tumorous esophageal epithelial tissues. IHC results revealed TACC3 expression was significantly correlated to differentiation (p = 0.017) and lymphoid nodal status (p = 0.028). The patients with high-expression of TACC3 had a significantly poor prognosis compared to those of low-expression (p = 0.017), especially in the patients at stages I–II (p = 0.028). Multivariate analysis indicated that TACC3 expression was an independent prognostic factor for ESCC patients (p = 0.025). Knockdown of TACC3 inhibited the ability of cell proliferation, colony formation and migration. This study first identifies TACC3 not only as a useful biomarker for diagnose and prognosis of ESCC, but also as a potential therapeutic target for patients with ESCC. PMID:25760075

  8. Increasing toxicity during neoadjuvant radiochemotherapy as positive prognostic factor for patients with esophageal carcinoma.

    PubMed

    Hennies, S; Hermann, R M; Gaedcke, J; Grade, M; Hess, C F; Christiansen, H; Wolff, H A

    2014-01-01

    The aim of this study was to correlate acute organ toxicity during preoperative radiochemotherapy with overall survival and tumor regression for patients with primarily operable esophageal carcinoma. From 1995 to 2002, 60 patients with primarily operable esophageal carcinoma were treated in a preoperative setting at our department. Thirty-three percent of the patients had International Union against Cancer (UICC)-stage II tumors, 62% had UICC-stage III tumors, and 5% had UICC-stage IVA tumors. All patients received irradiation (40?Gy at 2?Gy/fraction). Chemotherapy for all patients with adenocarcinoma and, from 2001, also for patients with squamous cell carcinoma consisted of two cycles, 5-fluorouracil and cisplatinum; between 1995 and 2001, patients with squamous cell carcinoma received three courses of chemotherapy (folinic acid, etoposide, 5-fluorouracil, and cisplatinum every 3 weeks) before and further cisplatinum and etoposide during radiotherapy. We found a significant correlation between acute organ toxicity and histopathological tumor regression, as well as overall survival. The probability to achieve tumor regression grade 1 after radiochemotherapy was nearly four times higher for patients with worsening of odynophagia than for those without an increase (odds ratio: 3.97). Patients with worsening of odynophagia had a 5-year overall-survival rate of 66% compared with 39% in patients without (P = 0.048). Our data indicate that normal tissue and tumor tissue may behave similar with respect to treatment response, as acute organ toxicity showed to be an independent prognostic marker in our patient population. The hypothesis should be further analyzed on biomolecular and clinical level in future clinical trials. PMID:23574528

  9. Esophageal reflexes modulate frontoparietal response in neonates: Novel application of concurrent NIRS and provocative esophageal manometry

    PubMed Central

    Pakiraih, Joanna F.; Hasenstab, Kathryn A.; Dar, Irfaan; Gao, Xiaoyu; Bates, D. Gregory; Kashou, Nasser H.

    2014-01-01

    Central and peripheral neural regulation of swallowing and aerodigestive reflexes is unclear in human neonates. Functional near infrared spectroscopy (NIRS) is a noninvasive method to measure changes in oxyhemoglobin (HbO) and deoxyhemoglobin (HbD). Pharyngoesophageal manometry permits evaluation of aerodigestive reflexes. Modalities were combined to investigate feasibility and to test neonatal frontoparietal cortical changes during pharyngoesophageal (visceral) stimulation and/or swallowing. Ten neonates (45.6 ± 3.0 wk postmenstrual age, 4.1 ± 0.5 kg) underwent novel pharyngoesophageal manometry concurrent with NIRS. To examine esophagus-brain interactions, we analyzed cortical hemodynamic response (HDR) latency and durations during aerodigestive provocation and esophageal reflexes. Data are presented as means ± SE or percent. HDR rates were 8.84 times more likely with basal spontaneous deglutition compared with sham stimuli (P = 0.004). Of 182 visceral stimuli, 95% were analyzable for esophageal responses, 38% for HDR, and 36% for both. Of analyzable HDR (n = 70): 1) HbO concentration (?mol/l) baseline 1.5 ± 0.7 vs. 3.7 ± 0.7 poststimulus was significant (P = 0.02), 2) HbD concentration (?mol/l) between baseline 0.1 ± 0.4 vs. poststimulus ?0.5 ± 0.4 was not significant (P = 0.73), and 3) hemispheric lateralization was 21% left only, 29% right only, and 50% bilateral. During concurrent esophageal and NIRS responses (n = 66): 1) peristaltic reflexes were present in 74% and HDR in 61% and 2) HDR was 4.75 times more likely with deglutition reflex vs. secondary peristaltic reflex (P = 0.016). Concurrent NIRS with visceral stimulation is feasible in neonates, and frontoparietal cortical activation is recognized. Deglutition contrasting with secondary peristalsis is related to cortical activation, thus implicating higher hierarchical aerodigestive protective functional neural networks. PMID:24789204

  10. Esophageal reflexes modulate frontoparietal response in neonates: Novel application of concurrent NIRS and provocative esophageal manometry.

    PubMed

    Jadcherla, Sudarshan R; Pakiraih, Joanna F; Hasenstab, Kathryn A; Dar, Irfaan; Gao, Xiaoyu; Bates, D Gregory; Kashou, Nasser H

    2014-07-01

    Central and peripheral neural regulation of swallowing and aerodigestive reflexes is unclear in human neonates. Functional near infrared spectroscopy (NIRS) is a noninvasive method to measure changes in oxyhemoglobin (HbO) and deoxyhemoglobin (HbD). Pharyngoesophageal manometry permits evaluation of aerodigestive reflexes. Modalities were combined to investigate feasibility and to test neonatal frontoparietal cortical changes during pharyngoesophageal (visceral) stimulation and/or swallowing. Ten neonates (45.6 ± 3.0 wk postmenstrual age, 4.1 ± 0.5 kg) underwent novel pharyngoesophageal manometry concurrent with NIRS. To examine esophagus-brain interactions, we analyzed cortical hemodynamic response (HDR) latency and durations during aerodigestive provocation and esophageal reflexes. Data are presented as means ± SE or percent. HDR rates were 8.84 times more likely with basal spontaneous deglutition compared with sham stimuli (P = 0.004). Of 182 visceral stimuli, 95% were analyzable for esophageal responses, 38% for HDR, and 36% for both. Of analyzable HDR (n = 70): 1) HbO concentration (?mol/l) baseline 1.5 ± 0.7 vs. 3.7 ± 0.7 poststimulus was significant (P = 0.02), 2) HbD concentration (?mol/l) between baseline 0.1 ± 0.4 vs. poststimulus -0.5 ± 0.4 was not significant (P = 0.73), and 3) hemispheric lateralization was 21% left only, 29% right only, and 50% bilateral. During concurrent esophageal and NIRS responses (n = 66): 1) peristaltic reflexes were present in 74% and HDR in 61% and 2) HDR was 4.75 times more likely with deglutition reflex vs. secondary peristaltic reflex (P = 0.016). Concurrent NIRS with visceral stimulation is feasible in neonates, and frontoparietal cortical activation is recognized. Deglutition contrasting with secondary peristalsis is related to cortical activation, thus implicating higher hierarchical aerodigestive protective functional neural networks. PMID:24789204

  11. Contractile profile of esophageal and gastric fundus strips in experimental doxorubicin-induced esophageal atresia

    PubMed Central

    Capeto, F.A.; Lima, F.J.B.; Okoba, W.; Ramos, F.L.; Messias, T.F.A.; Rigonatto, G.A.; Sbragia, L.; Magalhães, P.J.C.; Melo-Filho, A.A.

    2015-01-01

    Esophageal atresia (EA) is characterized by esophageal and gastric motility changes secondary to developmental and postsurgical damage. This study evaluated the in vitro contractile profile of the distal esophagus and gastric fundus in an experimental model of EA induced by doxorubicin (DOXO). Wistar pregnant rats received DOXO 2.2 mg/kg on the 8th and 9th gestational days. On day 21.5, fetuses were collected, sacrificed, and divided into groups: control, DOXO without EA (DOXO-EA), and DOXO with EA (DOXO+EA). Strips from the distal esophagus and gastric fundus were mounted on a wire myograph and isolated organ-bath system, respectively, and subjected to increasing concentrations of carbamylcholine chloride (carbachol, CCh). The isolated esophagus was also stimulated with increasing concentrations of KCl. In esophagus, the concentration-effect curves were reduced in response to CCh in the DOXO+EA and DOXO-EA groups compared to the control group (P<0.05). The maximum effect values (Emax) for DOXO+EA and DOXO-EA were significantly lower than control (P<0.05), but the half-maximal effective concentration (EC50) values were not significantly different when the three groups were compared (P>0.05). In response to KCl, the distal esophagus samples in the three groups were not statistically different with regard to Emax or EC50 values (P>0.05). No significant difference was noted for EC50 or Emax values in fundic strips stimulated with CCh (P>0.05). In conclusion, exposure of dams to DOXO during gestation inhibited the contractile behavior of esophageal strips from offspring in response to CCh but not KCl, regardless of EA induction. The gastric fundus of DOXO-exposed offspring did not have altered contractile responsiveness to cholinergic stimulation. PMID:25760030

  12. Clinicopathologic Characteristics of Esophageal Cancer Patients in Northwest Iran - Very Low Incidence of Adenocarcinomas

    Microsoft Academic Search

    Yousef Bafandeh; Shahriar Hashemzadeh; Mohsen Sokouti; Heidar Esmaili

    2006-01-01

    Aims: Iran is one of the known countries with a high incidence of esophageal cancer in Asia .We have recently shown that the incidence of Barrett's esophagus , a precancerous lesion for esophageal adenocarcinoma (AC) is very low in the north -west of the country . Therefore, we hypothesized that esophageal AC would also be lower than in the Western

  13. Clinical Symptoms in Endoscopic Reflux Esophagitis: Evaluation in 8031 Adult Subjects

    Microsoft Academic Search

    Kazuyo Okamoto; Ryuichi Iwakiri; Mitsuru Mori; Megumi Hara; Kayoko Oda; Akiko Danjo; Akifumi Ootani; Hiroyuki Sakata; Kazuma Fujimoto

    2003-01-01

    This study aimed to evaluate the correlation between symptoms and endoscopic findings in reflux esophagitis. Subjects, 8031 persons without medication for gastrointestinal disease, were briefly asked about the presence of heartburn, dysphagia, odynophagia, and acid regurgitation by associated medical staff before endoscopy for assessment of esophagitis utilizing the Los Angeles Classification. Endoscopically, 1199 (14.9%) were classified as positive reflux esophagitis,

  14. Thoughts on the Complex Relationship Between Gastroesophageal Reflux Disease and Eosinophilic Esophagitis

    Microsoft Academic Search

    Stuart Jon Spechler; Robert M. Genta; Rhonda F. Souza

    2007-01-01

    Recent data suggest that the interaction between gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be complex, and that the notion of establishing a clear distinction between the two disorders may be too simplistic. There are at least four situations in which GERD might be associated with esophageal eosinophils: (a) GERD causes esophageal injury that results in a mild eosinophilic

  15. Failed Nissen fundoplication in two patients who had persistent vomiting and eosinophilic esophagitis

    Microsoft Academic Search

    Chris A Liacouras

    1997-01-01

    The following report describes two patients who had chronic symptoms of gastroesophageal reflux and persistent histological esophagitis, despite aggressive medical antireflux therapy, who continued to have esophagitis and remained symptomatic post antireflux surgery (Nissen fundoplication). Both patients demonstrated a severe eosinophilic esophagitis with normal gastric and duodenal histology before and after surgery. Postoperatively, each received the diagnosis of allergic enteritis

  16. A new partially deprotonated mixed-valence manganese(II,III) hydroxide-arsenate with electronic conductivity: magnetic properties of high- and room-temperature sarkinite.

    PubMed

    de Pedro, Imanol; Rojo, Jose M; Rius, Jordi; Vallcorba, Oriol; Ruiz de Larramendi, Idoia; Rodríguez Fernández, Jesús; Lezama, Luis; Rojo, Teofilo

    2012-05-01

    A new three-dimensional hydroxide-arsenate compound called compound 2 has been synthesized by heating (in air) of the sarkinite phase, Mn(2)(OH)AsO(4) (compound 1), with temperature and time control. The crystal structure of this high-temperature compound has been solved by Patterson-function direct methods. A relevant feature of this new material is that it is actually the first member of the adamite-type family with mixed-valence manganese(II,III) and electronic conductivity. Crystal data: a = 6.7367(5) Å, b = 7.5220(6) Å, c = 9.8117(6) Å, ? = 92.410(4)°, ? = 109.840(4)°, ? = 115.946(4)°, P1?. The unit cell content derived from Rietveld refinement is Mn(8)(O(4)H(x))(AsO(4))(4). Its framework, projected along [111], is characterized by rings of eight Mn atoms with the OH(-)/O(2-) inside the rings. These rings form an almost perfect hexagonal arrangement with the AsO(4) groups placed in between. Bond-valence analysis indicates both partial deprotonation (x ? 3) and the presence of Mn in two different oxidation states (II and III), which is consistent with the electronic conductivity above 300 °C from electrochemical measurements. The electron paramagnetic resonance spectra of compound 1 and of its high-temperature form compound 2 show the presence of antiferromagnetic interactions with stronger magnetic coupling for the high-temperature phase. Magnetization measurements of room-temperature compound 1 show a complex magnetic behavior, with a three-dimensional antiferromagnetic ordering and magnetic anomalies at low temperatures, whereas for compound 2, an ordered state is not reached. Magnetostructural correlations indicate that superexchange interactions via oxygen are present in both compounds. The values of the magnetic exchange pathways [Mn-O-Mn] are characteristic of antiferromagnetic couplings. Notwithstanding, the existence of competition between different magnetic interactions through superexchange pathways can cause the complex magnetic behavior of compound 1. The loss of three-dimensional magnetic ordering by heating of compound 1 could well be based on the presence of Mn(3+) ions (d(4)) in compound 2. PMID:22519723

  17. Synthesis of mixed-valence hexanuclear Mn(ii/iii) clusters from its Mn(ii) precursor: variations of catecholase-like activity and magnetic coupling.

    PubMed

    Kar, Paramita; Ida, Yumi; Kanetomo, Takuya; Drew, Michael G B; Ishida, Takayuki; Ghosh, Ashutosh

    2015-05-19

    One Mn(ii) coordination polymer, [Mn(o-(NO2)C6H4COO)2(pyz)(H2O)]n (), has been synthesized and oxidized with n-Bu4NMnO4 in non-aqueous media to two mixed-valence hexanuclear Mn(ii/iii) complexes [MnMnO2(pyz)0.61/(MeOH)0.39(o-(NO2)C6H4COO)10·(H2O)·{(CH3)2CO}2]·(CH3)2CO () and [MnMnO2(pyz)0.28/(MeCN)3.72(o-(NO2)C6H4COO)10·(H2O)] () (where pyz = pyrazine). All three complexes were characterized by elemental analyses, IR spectroscopy, single-crystal X-ray diffraction analyses, and variable-temperature magnetic measurements. The structural analyses reveal that complex is comprised of linear chains of pyz bridged Mn(ii), which are further linked to one another by syn-anti carboxylate bridges, giving rise to a two-dimensional (2D) net. Complexes and feature mixed valence [MnMn] units in which each of the six manganese centres reside in an octahedral environment. Apart from the variations in terminal ligands (acetone for and acetonitrile for ), the complexes are very similar. Using 3,5-di-tert-butyl catechol (3,5-DTBC) as the substrate, the catecholase-like activity of the complexes has been studied and it is found that the mixed valent Mn6 complexes ( and ) are much more active towards aerial oxidation of catechol compared to the Mn(ii) complex (). Variable-temperature (1.8-300 K) magnetic susceptibility measurements showed the presence of antiferromagnetic coupling in all three complexes. The magnetic data have been fitted with a 2D quadratic model derived by Lines, giving the exchange constant J/kB = -0.0788(5) K for . For and , antiferromagnetic interactions within the Mn6 cluster have been fitted with models containing three exchange constants: JA/kB = -70 K, JB/kB = -0.5 K, JC/kB = -2.9 K for and JA/kB = -60 K, JB/kB = -0.3 K, JC/kB = -2.8 K for . PMID:25928181

  18. Hypersensitivity to acid is associated with impaired esophageal mucosal integrity in patients with gastroesophageal reflux disease with and without esophagitis.

    PubMed

    Weijenborg, Pim W; Smout, André J P M; Verseijden, Caroline; van Veen, Henk A; Verheij, Joanne; de Jonge, Wouter J; Bredenoord, Albert J

    2014-08-01

    Increased esophageal sensitivity and impaired mucosal integrity have both been described in patients with gastroesophageal reflux disease, but the relationship between hypersensitivity and mucosal integrity is unclear. The aim of the present study was to investigate acid sensitivity in patients with erosive and nonerosive reflux disease and control subjects to determine the relation with functional esophageal mucosal integrity changes as well as to investigate cellular mechanisms of impaired mucosal integrity in these patients. In this prospective experimental study, 12 patients with nonerosive reflux disease, 12 patients with esophagitis grade A or B, and 11 healthy control subjects underwent an acid perfusion test and upper endoscopy. Mucosal integrity was measured during endoscopy by electrical tissue impedance spectroscopy and biopsy specimens were analyzed in Ussing chambers for transepithelial electrical resistance, transepithelial permeability and gene expression of tight junction proteins and filaggrin. Patients with nonerosive reflux disease and esophagitis were more sensitive to acid perfusion compared with control subjects, having a shorter time to perception of heartburn and higher perceived intensity of heartburn. In reflux patients, enhanced acid sensitivity was associated with impairment of in vivo and vitro esophageal mucosal integrity. Mucosal integrity was significantly impaired in patients with esophagitis, displaying higher transepithelial permeability and lower extracellular impedance. Although no significant differences in the expression of tight junction proteins were found in biopsies among patient groups, mucosal integrity parameters in reflux patients correlated negatively with the expression of filaggrin. In conclusion, sensitivity to acid is enhanced in patients with gastroesophageal reflux disease, irrespective of the presence of erosions, and is associated with impaired esophageal mucosal integrity. Mucosal integrity of the esophagus is associated with the expression of filaggrin. PMID:24924748

  19. Volumetric modulated arc radiotherapy for esophageal cancer

    SciTech Connect

    Vivekanandan, Nagarajan, E-mail: viveknaren@hotmail.com [Department of Medical Physics, Cancer Institute, Chennai (India); Sriram, Padmanaban; Syam Kumar, S.A.; Bhuvaneswari, Narayanan; Saranya, Kamalakannan [Department of Medical Physics, Cancer Institute, Chennai (India)

    2012-04-01

    A treatment planning study was performed to evaluate the performance of volumetric arc modulation with RapidArc (RA) against 3D conformal radiation therapy (3D-CRT) and conventional intensity-modulated radiation therapy (IMRT) techniques for esophageal cancer. Computed tomgraphy scans of 10 patients were included in the study. 3D-CRT, 4-field IMRT, and single-arc and double-arc RA plans were generated with the aim to spare organs at risk (OAR) and healthy tissue while enforcing highly conformal target coverage. The planning objective was to deliver 54 Gy to the planning target volume (PTV) in 30 fractions. Plans were evaluated based on target conformity and dose-volume histograms of organs at risk (lung, spinal cord, and heart). The monitor unit (MU) and treatment delivery time were also evaluated to measure the treatment efficiency. The IMRT plan improves target conformity and spares OAR when compared with 3D-CRT. Target conformity improved with RA plans compared with IMRT. The mean lung dose was similar in all techniques. However, RA plans showed a reduction in the volume of the lung irradiated at V{sub 20Gy} and V{sub 30Gy} dose levels (range, 4.62-17.98%) compared with IMRT plans. The mean dose and D{sub 35%} of heart for the RA plans were better than the IMRT by 0.5-5.8%. Mean V{sub 10Gy} and integral dose to healthy tissue were almost similar in all techniques. But RA plans resulted in a reduced low-level dose bath (15-20 Gy) in the range of 14-16% compared with IMRT plans. The average MU needed to deliver the prescribed dose by RA technique was reduced by 20-25% compared with IMRT technique. The preliminary study on RA for esophageal cancers showed improvements in sparing OAR and healthy tissue with reduced beam-on time, whereas only double-arc RA offered improved target coverage compared with IMRT and 3D-CRT plans.

  20. Free radical scavengers prevent reflux esophagitis in rats.

    PubMed

    Wetscher, G J; Hinder, P R; Bagchi, D; Perdikis, G; Redmond, E J; Glaser, K; Adrian, T E; Hinder, R A

    1995-06-01

    Free radical damage in reflux esophagitis of rats induced by 24-hr duodenojejunal ligation was studied. Oxygen free radicals were selectively blocked. Groups were: sham operation, reflux, reflux + superoxide dismutase (SOD), catalase, dimethylthiourea, allopurinol, and inactivated SOD or inactivated catalase alone or in the combination SOD + catalase or SOD + catalase + dimethylthiourea + allopurinol. Macroscopic esophagitis was inhibited only by SOD, alone or in combination with other agents. Esophageal mucosal lipid peroxidation was 10-fold increased in the reflux group compared to the sham group (P < 0.05). This response was damped by SOD > catalase (P < 0.05) but not by the inactivated enzymes, dimethylthiourea or allopurinol. SOD + catalase showed no significant improvement on SOD alone. Total inhibition of lipid peroxidation was achieved by combining all scavengers. Total glutathione (GSH) in the esophageal mucosa was stimulated by reflux. This response was inhibited by scavengers equivalent to their efficacy in preventing lipid peroxidation. It is concluded that reflux esophagitis is associated with free radical release with O2- being the main source. Free radicals appear to stimulate GSH production in this prolonged oxidative stress. PMID:7781450

  1. Do We Know What Causes Eosinophilic Esophagitis? A Mechanistic Update.

    PubMed

    Runge, Thomas M; Dellon, Evan S

    2015-09-01

    The mechanisms underlying eosinophilic esophagitis (EoE) have been intensely investigated, and significant advances have been made in understanding the pathogenesis of EoE. EoE is defined as a chronic immune/antigen-mediated disease, characterized clinically by symptoms of esophageal dysfunction and histologically by an esophageal eosinophilic infiltrate. In this paper, we will review the current knowledge of EoE pathophysiology based on both animal and human data and discuss possible etiologic mechanisms from the genetic and environmental perspectives. EoE is a Th2-predominant inflammatory process triggered by allergens. Proinflammatory cytokines and chemokines recruit eosinophils and other effector cells, such as mast cells, into the esophageal epithelium, where they cause direct damage and promote esophageal remodeling. The genetic expression profile of EoE has been described, and several single nucleotide polymorphisms have been identified and associated with EoE. While this genetic contribution is important, it is difficult to postulate that EoE is primarily a genetic disease. Given the rapid epidemiologic changes in the incidence and prevalence of EoE over the past two decades, environmental factors may be the driving force. While it is not known what causes EoE in an individual patient at a specific time, the current hypothesis is that there is a complex interaction between genetic factors and environmental exposures that remains to be elucidated. PMID:26205715

  2. Evaluation of safety and immunogenicity of HNVAC, an MDCK-based H1N1 pandemic influenza vaccine, in Phase I single centre and Phase II/III multi-centre, double-blind, randomized, placebo-controlled, parallel assignment studies.

    PubMed

    Basavaraj, V H; Sampath, G; Hegde, Nagendra R; Mohan, V Krishna; Ella, Krishna M

    2014-07-31

    The clinical evaluation of the MDCK-based H1N1 pandemic influenza vaccine HNVAC in adults aged 18-65 years is reported. In the Phase I randomized, double-blind, placebo-controlled, single-centre study, 160 subjects were parallelly assigned 3:1 to vaccine:placebo groups (n=60:20) with both the aluminium hydroxide adjuvanted and non-adjuvanted vaccine formulations. A single dose of both the formulations containing 15 ?g of haemagglutinin protein showed minimal adverse reactions, the most common of which were pain at injection site (11.67%) and fever (10.00%). Both formulations produced 74-81% seroprotection (SRP: titre of ?40), 67-70% seroconversion (SRC: four-fold increase in titres between days 0 and 21), and a four-fold increase in geometric mean titres (GMT). Aluminium hydroxide did not have a significant effect either on immunogenicity or on reactogenicity. Nevertheless, based on its recognized positive effects on the stability and immunogenicity of many vaccines, and its marginal benefit in both pre-clinical and Phase I studies of HNVAC, alum adjuvanted HNVAC was further tested in a staggered Phase II/III randomized, double-blind, placebo-controlled, multi-centre study of 200 and 195 subjects, respectively, parallelly assigned 4:1 to adjuvanted vaccine and placebo groups. In these studies, the most common adverse reactions were pain at injection site (6.88% and 5.77% in Stage 1 and Stage 2, respectively) and fever (7.50% and 7.05%, respectively), and a single dose resulted in 87-90% SRP, 85-86% SRC, and a nearly six-fold increase in GMT, meeting or exceeding licensing criteria. It is concluded that HNVAC is safe and immunogenic to adults of 18-65 years. PMID:24856782

  3. UBE2D3 is a positive prognostic factor and is negatively correlated with hTERT expression in esophageal cancer

    PubMed Central

    GUAN, GE GE; WANG, WEN BO; LEI, BING XIN; WANG, QIAO LI; WU, LIN; FU, ZHEN MING; ZHOU, FU XIANG; ZHOU, YUN FENG

    2015-01-01

    Human telomerase reverse transcriptase (hTERT) is a critical factor in unlimited cell proliferation and immortalization, with numerous studies demonstrating that high expression of hTERT is a poor prognostic factor in various types of cancer. Ubiquitin-conjugating enzyme E2D 3 (UBE2D3) is a member of the E2 family, and participates in the ubiquitin proteasome pathway to regulate basic cellular activities, such as cell cycle control, the DNA damage response, apoptosis, and tumorigenesis. Our previous study initially determined that downregulation of UBE2D3 expression increases hTERT expression and cell proliferation, however, the association between the expression of these two proteins and their functions in cancer tissues remains unknown. Therefore, the protein expression levels of hTERT and UBE2D3 were evaluated in 150 esophageal cancer and 30 adjacent healthy tissue samples by performing immunohistochemical analysis. Concurrently, the clinicopathological data of the enrolled patients were obtained to allow correlation analysis. It was identified that the expression of hTERT in the esophageal cancer tissues was significantly higher compared with that of the adjacent tissues (P=0.015), however, the expression of UBE2D3 was significantly lower in esophageal cancer tissues than the adjacent tissues (P=0.001). Additionally, the study demonstrated that hTERT was significantly upregulated in poorly-differentiated, advanced tumor-node-metastasis (TNM) stage cancer tissues (P<0.05 for all), however, UBE2D3 expression was downregulated in poorly-differentiated, lymph node invaded cancer tissues and recurrent cases. It was also identified that traditional factors, including tumor location, T stage, lymph node status, TNM stage, and molecular factors of hTERT and UBE2D3, were significantly associated with overall survival time (P<0.05 for all). Furthermore, UBE2D3, lymph node status and tumor location were independent prognostic factors for esophageal cancer in multivariate analysis. Most notably, hTERT and UBE2D3 expression were negatively correlated with each other. In conclusion, the findings of the present study indicated that hTERT and UBE2D3 proteins appear to be involved in the development of esophageal cancer, that UBE2D3 may a positive prognostic factor for esophageal cancer, and that UBE2D3 and hTERT expression levels are inversely correlated. PMID:25789002

  4. Radionuclide transit: a sensitive screening test for esophageal dysfunction

    SciTech Connect

    Russell, C.O.; Hill, L.D.; Holmes, E.R. III; Hull, D.A.; Gannon, R.; Pope, C.E. II

    1981-05-01

    The purpose of this study was to extend existing nuclear medicine techniques for the diagnosis of esophageal motor disorders. A standard homogeneous bolus of 99mtechnetium sulfur colloid in water was swallowed in the supine position under the collimator of a gamma camera linked to a microprocessor. Bolus transit was recorded at 0.4-s intervals, and the movie obtained was used to analyze transit in an objective manner. Ten normal volunteers and 30 subjects with dysphagia not related to mechanical obstruction were studied with this technique. Radionuclide transit studies detected a higher incidence of esophageal motor abnormality than manometry or radiology in the dysphagia group. In addition a definitive description of the functional problem was possible in most cases. Radionuclide transit is a safe noninvasive test and suitable as a screening test for esophageal motor disorders.

  5. Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis

    SciTech Connect

    Maddern, G.J.; Horowitz, M.; Jamieson, G.G.; Chatterton, B.E.; Collins, P.J.; Roberts-Thomson, P.

    1984-10-01

    Gastric and esophageal emptying were assessed using scintigraphic techniques in 12 patients with progressive systemic sclerosis and 22 normal volunteers. Esophageal emptying was significantly delayed in the patient group, with 7 of the 12 patients beyond the normal range. Gastric emptying was slower in patients than in controls, with 9 patients being outside the normal range for solid emptying and 7 patients outside the normal range for liquid emptying. Findings from gastric and esophageal emptying tests generally correlated well with symptoms of dysphagia and gastroesophageal reflux. However, 2 patients with normal emptying studies had symptomatic heartburn, and 2 patients with delay of both solid and liquid gastric emptying gave no history of gastroesophageal reflux. Delayed gastric emptying may be an important factor in the development of upper gastrointestinal symptoms in patients with progressive systemic sclerosis.

  6. An etiological role for aeroallergens and eosinophils in experimental esophagitis

    PubMed Central

    Mishra, Anil; Hogan, Simon P.; Brandt, Eric B.; Rothenberg, Marc E.

    2001-01-01

    Eosinophil infiltration into the esophagus is observed in diverse diseases including gastroesophageal reflux and allergic gastroenteritis, but the processes involved are largely unknown. We now report an original model of experimental esophagitis induced by exposure of mice to respiratory allergen. Allergen-challenged mice develop marked levels of esophageal eosinophils, free eosinophil granules, and epithelial cell hyperplasia, features that mimic the human disorders. Interestingly, exposure of mice to oral or intragastric allergen does not promote eosinophilic esophagitis, indicating that hypersensitivity in the esophagus occurs with simultaneous development of pulmonary inflammation. Furthermore, in the absence of eotaxin, eosinophil recruitment is attenuated, whereas in the absence of IL-5, eosinophil accumulation and epithelial hyperplasia are ablated. These results establish a pathophysiological connection between allergic hypersensitivity responses in the lung and esophagus and demonstrate an etiologic role for inhaled allergens and eosinophils in gastrointestinal inflammation. PMID:11134183

  7. Esophageal and esophagogastric junction cancers, version 1.2015.

    PubMed

    Ajani, Jaffer A; D'Amico, Thomas A; Almhanna, Khaldoun; Bentrem, David J; Besh, Stephen; Chao, Joseph; Das, Prajnan; Denlinger, Crystal; Fanta, Paul; Fuchs, Charles S; Gerdes, Hans; Glasgow, Robert E; Hayman, James A; Hochwald, Steven; Hofstetter, Wayne L; Ilson, David H; Jaroszewski, Dawn; Jasperson, Kory; Keswani, Rajesh N; Kleinberg, Lawrence R; Korn, W Michael; Leong, Stephen; Lockhart, A Craig; Mulcahy, Mary F; Orringer, Mark B; Posey, James A; Poultsides, George A; Sasson, Aaron R; Scott, Walter J; Strong, Vivian E; Varghese, Thomas K; Washington, Mary Kay; Willett, Christopher G; Wright, Cameron D; Zelman, Debra; McMillian, Nicole; Sundar, Hema

    2015-02-01

    Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Adenocarcinoma is more common in North America and Western European countries, originating mostly in the lower third of the esophagus, which often involves the esophagogastric junction (EGJ). Recent randomized trials have shown that the addition of preoperative chemoradiation or perioperative chemotherapy to surgery significantly improves survival in patients with resectable cancer. Targeted therapies with trastuzumab and ramucirumab have produced encouraging results in the treatment of advanced or metastatic EGJ adenocarcinomas. Multidisciplinary team management is essential for patients with esophageal and EGJ cancers. This portion of the NCCN Guidelines for Esophageal and EGJ Cancers discusses management of locally advanced adenocarcinoma of the esophagus and EGJ. PMID:25691612

  8. [Rubber-band ligation of esophageal and cardiac varices].

    PubMed

    Arnon, R; Zimmerman, J; Keret, D; Lysy, J; Wengrower, D; Fich, A; Goldin, E

    1993-01-15

    Esophageal sclerotherapy was the treatment of choice for bleeding esophageal varices in the past decade. It is effective for treating acute variceal bleeding, as well as eradicating esophageal varices for secondary prevention of bleeding. However, in more than 20% of patients sclerotherapy involves complications, some of which are serious. The high complication rate suggested the development of a new method that should be at least as effective and as easy to perform as sclerotherapy, but with fewer complications and side-effects. Endoscopic variceal ligation was developed at the University of Colorado and described in 1986. It is reported to control active variceal bleeding in about 90% of patients, and to eradicate varices in about 80% of surviving patients. Complications are rare. We have adapted the method in our unit and here describe out preliminary experience in 11 patients. PMID:8436323

  9. Eosinophilic esophagitis: a practical approach to diagnosis and management.

    PubMed

    Molina-Infante, Javier; Lucendo, Alfredo J

    2014-11-01

    Eosinophilic esophagitis (EoE) has emerged as a common cause of dysphagia and food impaction in children and adults. A trial of proton pump inhibitor (PPI) therapy is a mandatory diagnostic first step, given that at least one third of patients with suspected EoE will have PPI-responsive esophageal eosinophilia. Once EoE is diagnosed, short-and long-term therapeutic decision making may rely on patient symptoms, phenotype (inflammatory vs fibrostenotic) and preferences. Currently, the most reliable therapeutic targets are mucosal healing and caliber abnormalities resolution. Topical steroids followed by endoscopic dilation are recommended in symptomatic narrow caliber esophagus/strictures, whereas either topical steroids or dietary therapy are good short-term options for mucosal inflammation. Maintenance anti-inflammatory therapy is necessary to prevent esophageal fibrotic remodeling and stricture formation. PMID:24830679

  10. Management of an aorto-esophageal fistula, complicating a descending thoracic aortic aneurysm endovascularly repaired.

    PubMed

    Georvasili, Vaia K; Bali, Christina; Peroulis, Michalis; Kouvelos, George; Avgos, Stavros; Godevenos, Dimitris; Liakakos, Theodoros; Matsagkas, Miltiadis

    2014-05-18

    Aorto-esophageal fistula (AEF) is a rare but devastating complication of thoracic aorta endovascular repair (TEVAR). We report a case of a 64-year-old male who presented with chest pain and high CRP levels 10 months after TEVAR for a 9 cm diameter descending thoracic aortic aneurysm. The diagnosis of an AEF was confirmed and the patient was treated conservatively with broad spectrum antibiotics and total parental alimentation. After control of sepsis was achieved, esophagectomy with gastric tube reconstruction was performed and an omental pedicle was used to cover the aortic wall. No intervention to the aorta was made at that time due to the potentially infected mediastinum. The patient's recovery was uneventful and 2 years postoperatively he is in good condition and lives a normal life. Esophagectomy seems to be a mandatory stage of treatment in the setting of AEF. In cases where signs of graft infection are persistent, aortic surgery might be also necessary. PMID:24838140

  11. Infrared micro-spectroscopy for cyto-pathological classification of esophageal cells.

    PubMed

    Townsend, Douglas; Miljkovi?, Miloš; Bird, Benjamin; Lenau, Kathleen; Old, Oliver; Almond, Max; Kendall, Catherine; Lloyd, Gavin; Shepherd, Neil; Barr, Hugh; Stone, Nick; Diem, Max

    2015-04-01

    We report results from a study utilizing infrared spectral cytopathology (SCP) to detect abnormalities in exfoliated esophageal cells. SCP has been developed over the past decade as an ancillary tool to classical cytopathology. In SCP, the biochemical composition of individual cells is probed by collecting infrared absorption spectra from each individual, unstained cell, and correlating the observed spectral patterns, and the variations therein, against classical diagnostic methods to obtain an objective, machine-based classification of cells. In the past, SCP has been applied to the analysis and classification of cells exfoliated from the cervix and the oral cavity. In these studies, it was established that SCP can distinguish normal and abnormal cell types. Furthermore, SCP can differentiate between truly normal cells, and cells with normal morphology from the vicinity of abnormalities. Thus, SCP may be a valuable tool for the screening of early stages of dysplasia and pre-cancer. PMID:25594077

  12. Molecular Pathways: Pathogenesis and clinical implications of microbiome alteration in esophagitis and Barrett’s esophagus

    PubMed Central

    Yang, Liying; Francois, Fritz; Pei, Zhiheng

    2013-01-01

    Esophageal adenocarcinoma is preceded by the development of reflux-related intestinal metaplasia or Barrett’s esophagus which is a response to inflammation of the esophageal squamous mucosa, reflux esophagitis. Gastroesophageal reflux impairs the mucosal barrier in the distal esophagus, allowing chronic exposure of the squamous epithelium to the diverse microbial ecosystem or microbiome, and inducing chronic inflammation. The esophageal microbiome is altered in both esophagitis and Barrett's esophagus, characterized by a significant decrease in Gram-positive bacteria and an increase in Gram-negative bacteria in esophagitis and Barrett's esophagus. Lipopolysaccharides (LPS), a major structure of the outer membrane in Gram-negative bacteria, can up-regulate gene expression of proinflammatory cytokines via activation of the TLR4 and NF-kB pathway. The potential impact of LPS on reflux esophagitis may be through relaxation of the lower esophageal sphincter via iNOS and by delaying gastric emptying via COX-2. Chronic inflammation may be play a critical role in the progression from benign to malignant esophageal disease. Therefore analysis of the pathways leading to chronic inflammation in the esophagus may help to identify biomarkers in Barrett's esophagus patients for neoplastic progression and provide insight into molecular events suitable for therapeutic intervention in prevention of esophageal adenocarcinoma development in patients with reflux esophagitis and Barrett's esophagus. PMID:22344232

  13. Esophagitis in Sprague-Dawley rats is mediated by free radicals.

    PubMed

    Wetscher, G J; Perdikis, G; Kretchmar, D H; Stinson, R G; Bagchi, D; Redmond, E J; Adrian, T E; Hinder, R A

    1995-06-01

    Free radical-mediated esophagitis was studied during duodenogastroesophageal reflux (mixed reflux) or acid reflux in rats. The influence of reflux on esophageal glutathione levels was also examined. Mixed reflux caused more gross mucosal injury than acid reflux. Gross mucosal injury occurred in the mid-esophagus. Total glutathione (GSH) in the esophageal mucosa of control rats was highest in the distal esophagus. The time course of esophageal GSH in rats treated by mixed reflux showed a significant decrease 4 hr after initiation of reflux, followed by a significant increase from the 12th hour on. Mucosal GSH was increased in both reflux groups after 24 hr but significantly more so in the mixed than in the acid reflux group. The free radical scavenger superoxide dismutase (SOD) prevented esophagitis and was associated with decreased GSH levels. GSH depletion by buthionine sulfoximine (BSO) prevented esophagitis and stimulated SOD production in the esophageal mucosa. It is concluded that gastroesophageal reflux is associated with oxidative stress in the esophageal mucosa. The lower GSH levels in the mid-esophagus may predispose to damage in this area. Duodenogastroesophageal reflux causes more damage than pure acid reflux. Oxidative stress leads to GSH depletion of the esophageal mucosa in the first few hours following damage but then stimulates GSH production. GSH depletion by BSO does not worsen esophagitis since it increases the esophageal SOD concentration. PMID:7781451

  14. A Novel Approach to Management of Esophageal Pill Impaction

    PubMed Central

    Caufield, Sean; Lavery, Eric; Partridge, Brett

    2014-01-01

    A 26-year-old male presented with symptoms of acute esophageal obstruction immediately after swallowing an 800-mg ibuprofen tablet. Multiple attempts to extract the pill with a variety of traditional endoscopic retrieval devices were unsuccessful. We successfully destroyed the pill using a threaded-tip biliary stent retrieval device to drill a hole in the center of the pill, which allowed us to use a rat-tooth forceps to crush the pill. This case report demonstrates a novel use of this device in a challenging esophageal pill extraction.

  15. Paraneoplastic cutaneous lupus secondary to esophageal squamous cell carcinoma

    PubMed Central

    Tworek, Joseph; Schapiro, Brian; Zolotarevsky, Eugene

    2015-01-01

    Sporadic subacute cutaneous lupus erythematosus (SCLE) in an elderly man does not fit a typical demographic for the disease process. Using the McLean’s criteria we were able to establish a temporal relationship between the patient’s diagnosis of esophageal squamous cell carcinoma (SCC) and his dermatosis, both of which responded to cytotoxic chemotherapy. The clinical presentation and progression of the clinical illness is supportive of a very unusual and not previously reported paraneoplastic SCLE secondary to esophageal SCC. PMID:26029469

  16. Recent advances in the recognition and management of eosinophilic esophagitis.

    PubMed

    Eustace, Gregory; Gui, Xianyong; Iacucci, Marietta

    2015-01-01

    The incidence and recognition of eosinophilic esophagitis is increasing. Pathophysiological understanding of eosinophilic esophagitis is improving and an immunological reaction to ingested food is likely to play a significant role. Patients present with dysphagia and food bolus obstruction. Both histological and endoscopic criteria have been developed and validated. Dietary therapy, topical steroid therapy, proton pump inhibitors and endoscopic dilation are the main approaches to therapy; however, novel targeted therapies are being developed. Among the food items commonly implicated are wheat, dairy, nuts, soy, shellfish and eggs. A multidisciplinary approach to management in dedicated clinics may yield the best results. PMID:26076223

  17. A case of eosinophilic esophagitis caused by a cedar ball.

    PubMed

    Fukuoka, Keiko; Izumi, Toshinobu; Yaku, Hiroaki; Okada, Hirokazu; Tsubosaka, Mako; Okada, Yuki; Ikemura, Takahiro; Kawase, Yoshito

    2015-01-01

    A 65-year-old woman presented to our hospital with chief complaints of a strange sensation in her pharynx, dysphagia, and odynophagia. Upper gastrointestinal endoscopy showed multiple aphthae in the esophagus and she was diagnosed with eosinophilic esophagitis based on the results of biopsy. Swallowing therapy with fluticasone was scheduled; however, she subsequently developed urticaria. She was treated with systemic steroid therapy at another hospital, which improved her symptoms and endoscopic images. A detailed history revealed that she had experienced significant facial edema after making a cedar ball. It was considered that the eosinophilic esophagitis was possibly caused by cedar pollen. PMID:26050724

  18. Esophageal perforation after radiofrequency ablation for atrial fibrillation.

    PubMed

    Manouchehri, Namdar; Turner, Simon R; Lockwood, Evan; Sterns, Laurence D; Bédard, Eric Lr

    2014-11-01

    A 69-year-old man underwent left atrial radiofrequency ablation for atrial fibrillation. After 10 minutes, the procedure was terminated due to pericardial tamponade secondary to perforation during mapping. Pericardiocentesis resolved the tamponade. Ablation was completed one week later, and the patient was discharged. Two days later, he presented with odynophagia. Computed tomography demonstrated small bilateral pleural effusions. He was judged to be stable and was discharged again, but returned 2 days later with chest pain. He was found to have esophageal perforation with empyema, which was repaired using a muscle patch and esophageal stenting, successfully treating the lesion with minimal morbidity. PMID:24887888

  19. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial)

    PubMed Central

    2012-01-01

    Background For esophageal cancer patients, radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent. Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes. However, the percentage of cardiopulmonary complications associated with the transthoracic approach is high (50 to 70%). Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RATE) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes. RATE was accompanied with reduced blood loss, shorter ICU stay and improved lymph node retrieval compared with open esophagectomy, and the pulmonary complication rate, hospital stay and perioperative mortality were comparable. The objective is to evaluate the efficacy, risks, quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer. Methods/design This is an investigator-initiated and investigator-driven monocenter randomized controlled parallel-group, superiority trial. All adult patients (age ?18 and ?80 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 112) with resectable esophageal cancer are randomized in the outpatient department to either RATE (n = 56) or open three-stage transthoracic esophageal resection (n = 56). The primary outcome of this study is the percentage of overall complications (grade 2 and higher) as stated by the modified Clavien–Dindo classification of surgical complications. Discussion This is the first randomized controlled trial designed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer. If our hypothesis is proven correct, RATE will result in a lower percentage of postoperative complications, lower blood loss, and shorter hospital stay, but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy. The study started in January 2012. Follow-up will be 5 years. Short-term results will be analyzed and published after discharge of the last randomized patient. Trial registration Dutch trial register: NTR3291 ClinicalTrial.gov: NCT01544790 PMID:23199187

  20. Unprecedented structural variations in trinuclear mixed valence Co(II/III) complexes: theoretical studies, pnicogen bonding interactions and catecholase-like activities.

    PubMed

    Hazari, Alokesh; Kanta Das, Lakshmi; Kadam, Ramakant M; Bauzá, Antonio; Frontera, Antonio; Ghosh, Ashutosh

    2015-02-28

    Three new mixed valence trinuclear Co(II/III) compounds cis-[Co3L2(MeOH)2(N3)2(?1,1-N3)2] (1), trans-[Co3L2(H2O)2(N3)2(?1,1-N3)2]·(H2O)2 (2) and [Co3L(R)2(N3)3(?1,3-N3)] (3) have been synthesized by reacting a di-Schiff base ligand (H2L) or its reduced form [H2LR] (where H2L= N,N'-bis(salicylidene)-1,3-propanediamine and H2LR= N,N'-bis(2-hydroxybenzyl)-1,3-propanediamine) with cobalt perchlorate hexahydrate and sodium azide. All three products have been characterized by IR, UV-Vis and EPR spectroscopies, ESI-MS, elemental, powder and single crystal X-ray diffraction analyses. Complex 2 is an angular trinuclear species in which two terminal octahedral Co(III)N2O4 centers coordinate to the central octahedral cobalt(II) ion through ?2-phenoxido oxygen and ?1,1-azido nitrogen atoms along with two mutually cis-oxygen atoms of methanol molecules. On the other hand, in linear trinuclear complex , in addition to the ?2-phenoxido and ?1,1-azido bridges with terminal octahedral Co(III) centres, the central Co(II) is bonded with two mutually trans-oxygen atoms of water molecules. Thus the cis-trans configuration of the central Co(II) is solvent dependent. In complex 3, the two terminal octahedral Co(III)N2O4 centers coordinate to the central penta-coordinated Co(II) ion through double phenoxido bridges along with the nitrogen atom of a terminal azido ligand. In addition, the two terminal Co(III) are connected through a ?1,3-azido bridge that participates in pnicogen bonding interactions (intermolecular N-N interaction) as an acceptor. Both the cis and trans isomeric forms of 1 and 2 have been optimized using density functional theory (DFT) calculations and it is found that the cis configuration is energetically more favorable than the trans one. However, the trans configuration of 2 is stabilized by the hydrogen bonding network involving a water dimer. The pnicogen bonding interactions have been demonstrated using MEP surfaces and CSD search which support the counter intuitive electron acceptor ability of the ?1,3-azido ligand. Complexes 1-3 exhibit catecholase-like activities in the aerial oxidation of 3,5-di-tert-butylcatechol to the corresponding o-quinone. Kinetic data analyses of this oxidation reaction in acetonitrile reveal that the catecholase-like activity follows the order: 1 (kcat = 142 h(-1)) > 3 (kcat = 99 h(-1)) > 2 (kcat = 85 h(-1)). Mechanistic investigations of the catalytic behaviors by X-band EPR spectroscopy and estimation of hydrogen peroxide formation indicate that the oxidation reaction proceeds through the reduction of Co(III) to Co(II). PMID:25611163

  1. Comparison of Efficacy of Regional and Extensive Clinical Target Volumes in Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma

    SciTech Connect

    Qiao Xueying; Wang Wei; Zhou Zhiguo [Department of Radiation Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang (China); Gao Xianshu [Department of Radiation Oncology, Peking University First Hospital, Beijing (China); Chang, Joe Y. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: jychang@mdanderson.org

    2008-02-01

    Purpose: To compare and analyze the effect of different clinical target volumes (CTVs) on survival rate after postoperative radiotherapy (RT) for esophageal squamous cell carcinoma (SCC). Methods and Materials: We studied 102 patients who underwent postoperative RT after radical resection for esophageal SCC (T3/4 or N1). The radiation dose was {>=}50 Gy. In the extensive portal group (E group, 43 patients), the CTV encompassed the bilateral supraclavicular region, all mediastinal lymph nodes, the anastomosis site, and the left gastric and pericardial lymphatic. In the regional portal group (R group, 59 patients), the CTV was confined to tumor bed and the lymph nodes in the immediate region of the primary lesion. The 1-, 3-, and 5-year survival rates were compared between the groups, and multivariate/univariate analysis for factors predicting survival was studied. Results: For the entire group, the 1-, 3- and 5-year survival rates were 76.3%, 50.5%, and 42.9%, respectively (median survival, 30 months). The 1-, 3-, and 5-year survival rates were 76.5%, 52.1%, and 41.3%, respectively, in the E group and 76.2%, 49.2%, and 44.6%, respectively, in the R group (not significant). According to the multivariate analysis, N stage, number of lymph nodes with metastatic disease, and tumor length were the independent prognostic factors for survival. Conclusions: Using a regional portal in postoperative RT for esophageal SCC is not associated with compromised survival compared with extensive portal RT and therefore should be considered. N stage, number of affected lymph nodes, and tumor length predict poor survival.

  2. Early diagnosis of esophageal cancer. Analysis of 11 cases of esophageal mucosal cancer.

    PubMed Central

    Misumi, A; Harada, K; Murakami, A; Arima, K; Kondo, H; Akagi, M; Yagi, Y; Ikeda, T; Kobori, Y; Matsukane, H

    1989-01-01

    We reviewed 11 patients with esophageal mucosal carcinoma in various aspects to improve the early diagnosis of the disease. Eighteen lesions measuring 0.5 to 5.0 cm were confirmed histologically in the 11 cases. Histologically 10 of the 18 lesions were carcinomas in situ (ep cancer), and the other 8 lesions were carcinomas confined to the mucosa other than ep cancer (mm cancer); all 18 lesions were squamous cell carcinomas. Six (85.7%) of the seven mm cancers showed abnormal radiographic findings regardless of the size. Similarly these findings were noted on four of five (80%) ep carcinomas 2 cm or larger in size. All 15 lesions diagnosed before operation showed abnormal findings on conventional endoscopy regardless of the size and depth of transmural invasion. Morphologic change was observed in 9 lesions (53.3%), while 13 (86.7%) showed color change; most of the lesions (80%) were manifested as redness. Dyeing of the resected specimen with Lugol solution (Katayama Chemical Industries, Osaka, Japan) showed all 18 cancerous lesions as unstained areas. Among the 18 lesions, two lesions were unstained areas, which agreed with the areas determined histologically. An additional lesion was visible with dye endoscopy as an unstained area but it was not visible with radiography or conventional endoscopy. Dye endoscopy using Lugol solution is very important because it allows detection and evaluation of the extent of esophageal mucosal cancer. Images Figs. 3A and B. Fig. 4. Figs. 5A and B. Figs. 6A and B. Figs. 7A and B. Figs. 8A and B. Figs. 9A and B. Fig. 10. PMID:2589886

  3. Diagnosis and surgical treatment of esophageal gastrointestinal stromal tumors

    PubMed Central

    Zhang, Fang-Biao; Shi, Hong-Can; Shu, Yu-Sheng; Shi, Wei-Ping; Lu, Shi-Chun; Zhang, Xiang-Yan; Tu, Shao-Song

    2015-01-01

    AIM: To retrospectively evaluate our experience with the diagnosis and surgical resection of esophageal gastrointestinal stromal tumors (GISTs). METHODS: Between January 2003 and August 2014, five esophageal GIST cases were admitted to our hospital. In this study, the hospital records, surgery outcomes, tumor recurrence and survival of these patients were retrospectively reviewed. RESULTS: The median age of the patients was 45.6 years (range: 12-62 years). Three patients presented with dysphagia, and one patient presented with chest discomfort. The remaining patient was asymptomatic. Four patients were diagnosed with esophageal GISTs by a preoperative endoscopic biopsy. Three patients underwent esophagectomy, and two patients underwent video-assisted thoracoscopic surgery. The mean operating time was 116 min (range: 95-148 min), and the mean blood loss was 176 mL (range: 30-300 mL). All tumors were completely resected. The mean length of postoperative hospital stay was 8.4 d (range: 6-12 d). All patients recovered and were discharged successfully. The median postoperative follow-up duration was 48 mo (range: 29-72 mo). One patient was diagnosed with recurrence, one patient was lost to follow-up, and three patients were asymptomatic and are currently being managed with close radiologic and clinical follow-up. CONCLUSION: Surgery is the standard, effective and successful treatment for esophageal GISTs. Long-term follow-up is required to monitor recurrence and metastasis. PMID:25987788

  4. Emerging management concepts for eosinophilic esophagitis in children.

    PubMed

    Heine, Ralf G; Nethercote, Mark; Rosenbaum, Jeremy; Allen, Katrina J

    2011-07-01

    Eosinophilic esophagitis (EoE) is a newly recognized condition that appears to be increasing in incidence for as yet unknown reasons. It can occur at any age and presents both to gastroenterologists and allergists. Clinical manifestations range from gastrointestinal symptoms (vomiting, feeding difficulties, dysphagia or food bolus impaction) to co-existing atopic conditions (asthma, allergic rhinitis or eczema). The diagnosis requires demonstration of at least 15 eosinophils per high power field on esophageal histology, usually in the context of resistance to proton pump inhibitor treatment or a normal 24-h esophageal pH monitoring study. The differential diagnosis between EoE and gastroesophageal reflux disease (GERD) can be problematic as there is significant clinical overlap between both conditions. Although difficult-to-manage esophageal strictures are well recognized in patients with long-standing EoE, little is known about risk factors for the development of this complication. There is a paucity of data on both the natural history and optimal long-term management of EoE. Current treatment options include food allergen elimination diets, use of topical aerosolized corticosteroids, or a combination of the two. Pediatric case studies have been provided to illustrate the complexity of decision points that often arise in the management of these patients. This paper aims to discuss the various strategies currently available to clinicians in the management of EoE and highlights gaps in the current evidence base that urgently require further research. PMID:21545525

  5. Intrathoracic esophageal perforation: The merit of primary repair

    Microsoft Academic Search

    Richard I. Whyte; Mark D. Iannettoni; Mark B. Orringer

    1995-01-01

    Between 1976 and 1993, 22 patients with intrathoracic esophageal perforations, none associated with carcinoma, underwent primary repair regardless of the interval between perforation and the time of repair. Eighteen perforations were iatrogenic and four were spontaneous. The interval from perforation to operation was less than 12 hours in 10 patients, 12 to 24 hours in 3, and more than 24

  6. Nitinol Esophageal Stents: New Designs and Clinical Indications

    SciTech Connect

    Strecker, Ernst-Peter; Boos, Irene; Vetter, Sylvia; Strohm, Michael; Domschke, Sigurd [Department of Radiology and Nuclear Medicine, Diakonissen-Krankenhaus, Diakonissenstr. 28, D-76191 Karlsruhe (Germany)

    1996-11-15

    Purpose: To evaluate the clinical use of covered and noncovered, knitted nitinol stents in patients presenting new stent indications. Methods: Self-expandable, knitted nitinol stents were implanted in four patients for treatment of dysphagia. In two patients who had malignant strictures and had esophago-respiratory fistulae and in one patient with an esophagocutaneous fistula, polytetrafluoroethylene (PTFE)-covered stents were implanted. One patient received a noncovered stent, but a retrograde approach through a percutaneous endoscopic gastrostomy (PEG) fistula had to be chosen for recanalization of an esophageal occlusion. Two patients received stents for treatment of benign strictures. Results: Recanalization of the stricture and stent implantation were performed under fluoroscopic control without any procedure-related morbidity or mortality. Dysphagia improved in all patients and the esophageal fistulae could be sealed off by covered stents. During a maximum follow-up of 18 months, there was no stent migration or esophageal perforation. Complications observed were stent stenosis due to food impaction (1/4) and benign stent stenosis (2/2). Most complications could be treated by the interventional radiologist. Conclusion: Self-expandable, covered Nitinol stents provide an option for the treatment of dysphagia combined with esophageal fistulae. In combination with interventional radiology techniques, even complex strictures are accessible. For benign strictures, the value of stent treatment has not yet been proven.

  7. Coincidence of Nutritional Habits and Esophageal Cancer in Germany

    Microsoft Academic Search

    E. Wolfgarten; U. Rosendahl; T. Nowroth; J. Leers; R. Metzger; A. H. Hölscher; E. Bollschweiler

    2001-01-01

    Summary Introduction: The incidence rates for adenocarcinoma (AC) of the esophagus have risen rapidly in Western nations, whereas the incidence rates for esophageal squamous cell carcinoma (SCC) have remained nearly stable. There are studies about body mass index, smoking, alcohol, and development of AC or SCC. The aim of this study was to evaluate differences in nutritional habits of patients

  8. Ambulatory esophageal pH monitoring using a wireless system

    Microsoft Academic Search

    John E Pandolfino; Joel E Richter; Tina Ours; Jason M Guardino; Jennifer Chapman; Peter J Kahrilas

    2003-01-01

    ObjectivesLimitations of catheter-based esophageal pH monitoring are discomfort, inconvenience, and interference with normal activity. An alternative to conventional pH monitoring is the wireless Medtronic Bravo pH System. The aim of this study was to evaluate the safety, performance, and tolerability of this system.

  9. Etiology and chemoprevention of esophageal squamous cell carcinoma

    Microsoft Academic Search

    Gary D. Stoner; Ashok Gupta

    Squamous cell carcinoma (SCC) of the human esophagus has a multifactorial etiology involving several environ- mental and\\/or genetic factors. Current modalities of therapy for this disease offer poor survival and cure rates. Although a number of approaches could be undertaken to reduce the occurrence of esophageal SCC, including changes in lifestyle and improved nutrition, such approaches are not easily implemented.

  10. Esophageal atresia with tracheoesophageal fistula associated with situs inversus totalis.

    PubMed

    Barman, Shibsankar; Mandal, Kartik Chandra; Shukla, Ram Mohan; Mukhopadhyay, Biswanath

    2014-06-01

    Esophageal atresia with tracheoesophageal fistula with situs inversus totalis is an extremely rare association. We are presenting a case of a preterm neonate suffering from similar condition. Fistula ligation with primary repair was done via left thoracotomy to avoid technical difficulties. Preoperative echocardiography should be done to confirm dextrocardia and disposition of the aortic arch. PMID:25177126

  11. Preparation and characterization of a biologic scaffold from esophageal mucosa.

    PubMed

    Keane, Timothy J; Londono, Ricardo; Carey, Ryan M; Carruthers, Christopher A; Reing, Janet E; Dearth, Christopher L; D'Amore, Antonio; Medberry, Christopher J; Badylak, Stephen F

    2013-09-01

    Biologic scaffolds composed of extracellular matrix (ECM) are commonly used to facilitate a constructive remodeling response in several types of tissue, including the esophagus. Surgical manipulation of the esophagus is often complicated by stricture, but preclinical and clinical studies have shown that the use of an ECM scaffold can mitigate stricture and promote a constructive outcome after resection of full circumference esophageal mucosa. Recognizing the potential benefits of ECM derived from homologous tissue (i.e., site-specific ECM), the objective of the present study was to prepare, characterize, and assess the in-vivo remodeling properties of ECM from porcine esophageal mucosa. The developed protocol for esophageal ECM preparation is compliant with previously established criteria of decellularization and results in a scaffold that maintains important biologic components and an ultrastructure consistent with a basement membrane complex. Perivascular stem cells remained viable when seeded upon the esophageal ECM scaffold in-vitro, and the in-vivo host response showed a pattern of constructive remodeling when implanted in soft tissue. PMID:23777917

  12. Cyclosporine in the management of esophageal lichen planus

    PubMed Central

    Chaklader, M; Morris-Larkin, C; Gulliver, W; McGrath, J

    2009-01-01

    Lichen planus (LP) is an uncommon disorder of unknown etiology, mostly affecting patients in their fifth and sixth decade of life. It is believed to be an autoimmune process involving T cells directed against basal keratinocytes. It affects the skin, nails, oral pharynx and genitals. Esophageal involvement is quite rare and can cause strictures, ulcerations and squamous cell cancer. The present article describes the case of a 54-year-old woman who was referred for assessment of dysphagia that initially occurred with solids, which then progressed to soft foods but spared liquids. The patient reported a weight loss of 9.1 kg. An esophagogastroduodenoscopy was performed and she was subsequently diagnosed with pill esophagitis. At the same time, she was also diagnosed with oral LP, with no involvement of the esophagus. She was treated with a proton pump inhibitor that resolved her gastrointestinal symptoms. The symptoms returned one year later and a repeat esophagogastroduodenoscopy revealed white plaques due to LP. She was treated with intermittent glucocorticoids. Diagnosis of esophageal LP is crucial for the proper treatment. Some patients may require systemic immunosuppression and mechanical dilation to prevent weight loss. Surveillance endoscopies should be performed to monitor for squamous cell cancer. Cyclosporine has been used for genital and oral LP, but the present case is the first in which it has been used successfully to treat esophageal LP. PMID:19826643

  13. Preparation and Characterization of a Biologic Scaffold from Esophageal Mucosa

    PubMed Central

    Keane, Timothy J.; Londono, Ricardo; Carey, Ryan M.; Carruthers, Christopher A.; Reing, Janet E.; Dearth, Christopher L.; D’Amore, Antonio; Medberry, Christopher J.; Badylak, Stephen F.

    2013-01-01

    Biologic scaffolds composed of extracellular matrix (ECM) are commonly used to facilitate a constructive remodeling response in several types of tissue, including the esophagus. Surgical manipulation of the esophagus is often complicated by stricture, but preclinical and clinical studies have shown that the use of an ECM scaffold can mitigate stricture and promote a constructive outcome after resection of full circumference esophageal mucosa. Recognizing the potential benefits of ECM derived from homologous tissue (i.e., site-specific ECM), the objective of the present study was to prepare, characterize, and assess the in-vivo remodeling properties of ECM from porcine esophageal mucosa. The developed protocol for esophageal ECM preparation is compliant with previously established criteria of decellularization and results in a scaffold that maintains important biologic components and an ultrastructure consistent with a basement membrane complex. Perivascular stem cells remained viable when seeded upon the esophageal ECM scaffold in vitro, and the in-vivo host response showed a pattern of constructive remodeling when implanted in soft tissue. PMID:23777917

  14. Palliative Chemotherapy Does Not Improve Survival in Metastatic Esophageal Cancer

    Microsoft Academic Search

    Antoine Adenis; Nicolas Penel; Samy Horn; Sophie Dominguez; Marie Vanhuyse; Xavier Mirabel

    2010-01-01

    Background: The role of chemotherapy in metastatic esophageal carcinoma (MEC) remains a matter of debate. The aim of this retrospective study was to analyze the survival impact of chemotherapy after stratification for prognostic factors. Methods: Consecutive patients with MEC (1995 to 2008) were randomly assigned to a development (n = 171) and a validation cohort (n = 113). We had

  15. Esophageal foreign body in a 2-day-old calf

    PubMed Central

    Haas, Jackie

    2010-01-01

    A 2-day-old male Charolais crossbred calf presented with a section of an esophageal feeding tube partially obstructing his esophagus. External palpation of the neck confirmed the location of the obstruction to be within the cervical esophagus. A rumenotomy was performed and the foreign body was successfully removed. PMID:20592832

  16. [Tracheoesophageal fistula after the removal of esophageal foreign body].

    PubMed

    Szmeja, Z; Kruk-Zagajewska, A; Wa?niewska, E

    1999-01-01

    A case of 18 years old male with tracheoesophageal fistula as a result of esophageal foreign body (chestnut) is described. Foreign body was removed using esophagoscopy. Bronchofiberoscopy performed because of difficulties with swallowing and frequent airway infections revealed tracheoesophageal fistula. Fistula was closed from intratracheal access. Symptoms of dysfagia disappeared after surgery. PMID:10689920

  17. Polycyclic aromatic hydrocarbons and esophageal squamous cell carcinoma.

    PubMed

    Roshandel, Gholamreza; Semnani, Shahryar; Malekzadeh, Reza; Dawsey, Sanford M

    2012-11-01

    Esophageal cancer (EC) is the 8th most common cancer and the 6th most frequent cause of cancer mortality worldwide. Esophageal squamous cell carcinoma (ESCC) is the most common type of EC. Exposure to polycyclic aromatic hydrocarbons (PAHs) has been suggested as a risk factor for developing ESCC. In this paper we will review different aspects of the relationship between PAH exposure and ESCC. PAHs are a group of compounds that are formed by incomplete combustion of organic matter. Studies in humans have shown an association between PAH exposure and development of ESCC in many populations. The results of a recent case-control study in a high risk population in northeastern Iran showed a dramatic dose-response relationship between PAH content in non-tumor esophageal tissue (the target tissue for esophageal carcinogenesis) and ESCC case status, consistent with a causal role for PAH exposure in the pathogenesis of ESCC.  Identifying the main sources of exposure to PAHs may be the first and most important step in designing appropriate PAH-reduction interventions for controlling ESCC, especially in high risk areas. Coal smoke and drinking mate have been suggested as important modifiable sources of PAH exposure in China and Brazil, respectively. But the primary source of exposure to PAHs in other high risk areas for ESCC, such as northeastern Iran, has not yet been identified. Thus, environmental studies to determining important sources of PAH exposure should be considered as a high priority in future research projects in these areas. PMID:23102250

  18. Doctors, Engineers Develop New Wireless System To Detect Esophageal Reflux

    E-print Network

    Chiao, Jung-Chih

    that takes photos as it goes through the digestive tract, and Bravo capsule, another wireless systemDoctors, Engineers Develop New Wireless System To Detect Esophageal Reflux Science Daily -- UT Southwestern Medical Center doctors and UT Arlington engineers have developed a wireless monitoring system

  19. Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis

    Microsoft Academic Search

    Richard J Noel; Philip E Putnam; Margaret H Collins; Amal H Assa’ad; Jesus R Guajardo; Sean C Jameson; Marc E Rothenberg

    2004-01-01

    Background & Aims: Eosinophilic esophagitis (EE) is a recently recognized clinical disorder that is understood poorly. We aimed to determine the efficacy of swallowed fluticasone propionate on the immunopathologic features associated with EE. Methods: A retrospective analysis was performed on 20 pediatric patients with EE. Inclusion criteria specified a peak eosinophil density of ?24 cells per 400× field in the

  20. Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk

    Microsoft Academic Search

    Mitchell Kaplan; Ece A. Mutlu; Shriram Jakate; Keith Bruninga; John Losurdo; Joseph Losurdo; Ali Keshavarzian

    2003-01-01

    Background & Aims: Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described. Methods: Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic

  1. An Audit of Endoscopic Complications in Adult Eosinophilic Esophagitis

    Microsoft Academic Search

    Matthew S. Cohen; Adam B. Kaufman; Juan P. Palazzo; Daniel Nevin; Anthony J. DiMarino; Sidney Cohen

    2007-01-01

    Background & Aims: Eosinophilic esophagitis (EoE) in adults, characterized by the triad of dysphagia, a ringed esophagus, and mucosal eosinophilic infiltration, has asso- ciated complications that include vertical mucosal lacera- tions, instrumental perforation, and emesis-induced rup- ture. The aim of this study was to determine whether clinical, endoscopic, and histologic features can be used to predict the risk for development

  2. Molecular, genetic, and cellular bases for treating eosinophilic esophagitis.

    PubMed

    Rothenberg, Marc E

    2015-05-01

    Eosinophilic esophagitis (EoE) was historically distinguished from gastroesophageal reflux disease on the basis of histology and lack of responsiveness to acid suppressive therapy, but it is now appreciated that esophageal eosinophilia can respond to proton pump inhibitors. Genetic and environmental factors contribute to risk for EoE, particularly early-life events. Disease pathogenesis involves activation of epithelial inflammatory pathways (production of eotaxin-3 [encoded by CCL26]), impaired barrier function (mediated by loss of desmoglein-1), increased production and/or activity of transforming growth factor-?, and induction of allergic inflammation by eosinophils and mast cells. Susceptibility has been associated with variants at 5q22 (TSLP) and 2p23 (CAPN14), indicating roles for allergic sensitization and esophageal specific protease pathways. We propose that EoE is a unique disease characterized by food hypersensitivity; strong hereditability influenced by early-life exposures and esophageal-specific genetic risk variants; and allergic inflammation and that the disease is remitted by disrupting inflammatory and T-helper type 2 cytokine-mediated responses and through dietary elimination therapy. PMID:25666870

  3. New index to predict esophageal variceal bleeding in cirrhotic patients

    PubMed Central

    Xu, Xiao-Dan; Dai, Jian-Jun; Qian, Jian-Qing; Pin, Xun; Wang, Wei-Jun

    2014-01-01

    AIM: To develop a safe, simple, noninvasive and affordable system to predict esophageal variceal bleeding (EVB) in decompensated cirrhosis patients. METHODS: Four hundred and eighty-six patients with decompensated cirrhosis (238 males and 248 females), with a mean age of 63.1 ± 11.2 years, were admitted to Changshu Affiliated Hospital of Suzhou University between May 2008 and March 2011. Patients enrolled in this study underwent ultrasound-Doppler (US-Doppler) to assess left gastric vein (LGV) blood flow velocity (LGVV) and blood flow direction (LGVBFD), and were evaluated by the Model For End-Stage Liver Disease (MELD) scoring system. All patients received follow-up evaluations every three months. The resulting data were entered into a database after each time point collection. RESULTS: Four hundred and sixteen patients completed follow-up evaluations for an average of 31.6 mo (range: 12 to 47 mo). Fifty-one (12.3%) patients experienced EVB. The change in the MELD score over three months (?MELD), LGVV and LGVBFD were independently associated with EVB occurrence. MELD-US-Doppler Index (MUI), a new index, was developed and calculated using the following logistic regression equation: MUI = Logit (P) = 1.667 (?MELD) + 2.096 (LGVV) - 3.245 (LGVBFD) - 1.697. The area under the receiver operating characteristic curve for prediction of EVB occurrence was significantly higher for the MUI [0.858 (95%CI: 0.774-0.920)] than for ?MELD [0.734 (95%CI: 0.636-0.817); P < 0.05], LGVV [0.679 (95%CI: 0.578-0.769); P < 0.05] or LGVBFD [0.726 (95%CI: 0.627-0.810); P < 0.05] alone. When the MUI was set at 46, the index had high diagnostic accuracy (85.8%), with high specificity (80%) and sensitivity (87.27%). CONCLUSION: The MUI, a noninvasive and affordable index, can predict EVB occurrence in decompensated cirrhotic patients and serve as an alternative when conventional endoscopic screening is declined. PMID:24944493

  4. [A long-term survivor of cT4 esophageal carcinoma treated via a multimodal approach - a case report].

    PubMed

    Ikai, Atsushi; Fujiwara, Hitoshi; Shiozaki, Atsushi; Konishi, Hirotaka; Kosuga, Toshiyuki; Komatsu, Shuhei; Ichikawa, Daisuke; Okamoto, Kazuma; Morimura, Ryo; Kuriu, Yoshiaki; Ikoma, Hisashi; Nakanishi, Masayoshi; Ochiai, Toshiya; Sakakura, Chouhei; Otsuji, Eigo

    2014-11-01

    The patient was a 53-year-old man whose chief complaint was dysphagia. Pretreatment examination revealed 2 types of locally advanced esophageal squamous cell carcinoma at the middle to lower thoracic esophagus. A computed tomography (CT) scan showed a bulky primary tumor suspicious of aortic invasion and cardiac lymph node metastasis. The pretreatment diagnosis was cT4N2M0, cStageIVa. After induction chemotherapy with 5-fluorouracil (5-FU) and cisplatin (CDDP) (the FP regimen) according to the JCOG9907 regimen, subtotal esophagectomy and 2-field lymphadenectomy with retrosternal stomach roll reconstruction were performed. Intraoperatively, the primary tumor showed extensive and firm adhesion to the aortic wall. The postoperative diagnosis was pT4N0M0, pStageIII, RM1. Postoperative chemoradiotherapy (65 Gy+FP) was performed for the residual tumor at the aortic wall. The patient is alive without recurrences 4 years and 6 months after the esophagectomy. Downstaging of the tumor with induction chemotherapy and effective local control with surgery and postoperative chemoradiotherapy may have contributed to the patient's long-term survival. For multimodal treatment of cT4 esophageal cancer, an effective combination of chemotherapy, surgery, and chemoradiotherapy is essential to improve the treatment outcome. PMID:25731407

  5. Endoscopic evaluation of gastro-esophageal reflux disease.

    PubMed Central

    Armstrong, D.

    1999-01-01

    Endoscopy is, currently, the initial investigation of choice for the investigation of gastroesophageal reflux disease (GERD) in clinical practice and clinical research. Erosion severity is predictive of a patient's response to therapy and of the likelihood of relapse after therapy. It is, therefore, important to grade the severity of erosive reflux esophagitis, particularly in the context of clinical trials. The Savary-Miller endoscopic classification system is used widely but usage and interpretation are very variable. The "MUSE" (metaplasia [M], ulceration [U], stricturing [S] and erosions [E]) classification provides clear definitions of the relevant endoscopic features, and it is based on a standardized report form, which allows the endoscopist to make a clear record of esophagitis severity. Recent studies confirm that endoscopists can identify erosions or mucosal breaks, ulcers, strictures, and metaplasia reproducibly. The "L.A." (Los Angeles) classification describes four grades of esophagitis severity (A to D), based on the extent of esophageal lesions known as "mucosal breaks," but it does not record the presence or severity of other GERD lesions. Thus, for patients with "complicated" reflux disease, the "MUSE" classification offers a more comprehensive description of esophagitis severity. Endoscopy is not universally applicable: 40 to 60 percent of patients with typical reflux symptoms do not have esophageal erosions and are now considered to have "endoscopy negative reflux disease" (ENRD). Thus, endoscopy is not the final arbiter as to a diagnosis of reflux disease, and it is not, therefore, a necessary prerequisite to therapy. Endoscopy is indicated at first presentation for patients with alarm symptoms referable to the upper gastrointestinal tract. It has also been proposed that all patients with chronic GERD should have a "once-in-a-lifetime" endoscopy; in the absence of Barrett's esophagus or other complications, no follow-up is required unless the patient's symptoms change significantly. A surveillance program with multiple biopsies should be instituted if there is evidence of Barrett's esophagus. Endoscopic evaluation should document the presence and extent of esophageal erosions using the L.A. or MUSE classification systems; complications should also be documented and may be recorded using the MUSE classification. Non-erosive changes such as erythema may be ignored on the basis of present evidence, and there are no clear data to support the use of endoscopic biopsies for the diagnosis of GERD. PMID:10780570

  6. Integrin genetic variants and stage-specific tumor recurrence in patients with stage II and III colon cancer.

    PubMed

    Bohanes, P; Yang, D; Loupakis, F; LaBonte, M J; Gerger, A; Ning, Y; Lenz, C; Lenz, F; Wakatsuki, T; Zhang, W; Benhaim, L; El-Khoueiry, A; El-Khoueiry, R; Lenz, H-J

    2015-06-01

    Integrins (ITGs) are key elements in cancer biology, regulating tumor growth, angiogenesis and lymphangiogenesis through interactions of the tumor cells with the microenvironment. Moving from the hypothesis that ITGs could have different effects in stage II and III colon cancer, we tested whether a comprehensive panel of germline single-nucleotide polymorphisms (SNPs) in ITG genes could predict stage-specific time to tumor recurrence (TTR). A total of 234 patients treated with 5-fluorouracil-based chemotherapy at the University of Southern California were included in this study. Whole-blood samples were analyzed for germline SNPs in ITG genes using PCR-restriction fragment length polymorphism or direct DNA sequencing. In the multivariable analysis, stage II colon cancer patients with at least one G allele for ITGB3 rs4642 had higher risk of recurrence (hazard ratio (HR)=4.027, 95% confidence interval (95% CI) 1.556-10.421, P=0.004). This association was also significant in the combined stage II-III cohort (HR=1.975, 95% CI 1.194-3.269, P=0.008). The predominant role of ITGB3 rs4642 in stage II diseases was confirmed using recursive partitioning, showing that ITGB3 rs4642 was the most important factor in stage II diseases. In contrast, in stage III diseases the combined analysis of ITGB1 rs2298141 and ITGA4 rs7562325 allowed to identify three distinct prognostic subgroups (P=0.009). The interaction between stage and the combined ITGB1 rs2298141 and ITGA4 rs7562325 on TTR was significant (P=0.025). This study identifies germline polymorphisms in ITG genes as independent stage-specific prognostic markers for stage II and III colon cancer. These data may help to select subgroups of patients who may benefit from ITG-targeted treatments. PMID:25487679

  7. Esophageal Motion During Radiotherapy: Quantification and Margin Implications

    PubMed Central

    Cohen, Randi J.; Paskalev, Kamen; Litwin, Samuel; Price, Robert; Feigenberg, Steven J.; Konski, Andre

    2010-01-01

    Purpose To evaluate inter- and intra-fraction esophageal motion in the right-left (RL) and anterior-posterior (AP) directions using computed tomography (CT) in esophageal cancer patients. Methods and Materials Eight patients underwent CT simulation and CT-on-rails imaging before and after radiotherapy. Inter-fraction displacement was defined as differences between pre-treatment and simulation images. Intra-fraction displacement was defined as differences between pre- and post-treatment images. Images were fused using bone registries, adjusted to the carina. The mean, average of the absolute, and range of esophageal motion were calculated in RL and AP directions, above and below the carina. Results Thirty-one CT image sets were obtained. The incidence of esophageal inter-fraction motion ?5 was 24% and ?10 mm was 3%; intra-fraction motion ? 5mm was 13% and ?10 mm was 4%. The average RL motion was 1.8±5.1 mm, favoring leftward movement, and the average AP motion was 0.6±4.8 mm, favoring posterior movement. Average absolute motion was 4.2 mm or less in RL and AP directions. Motion was greatest in the RL direction above the carina. Coverage of 95% of esophageal mobility requires 12mm left, 8mm right, 10mm posterior, and 9mm anterior margins. Conclusion In all directions, the average of the absolute inter-fraction and intra-fraction displacement was 4.2 mm or less. These results support a 12 mm left, 8 mm right, 10 mm posterior, and 9 mm anterior margin for ITV and can guide margins for future IMRT trials to account for organ motion and set up error in 3-dimesional planning. PMID:20095993

  8. Efficacy of short period, low dose oral prednisolone for the prevention of stricture after circumferential endoscopic submucosal dissection (ESD) for esophageal cancer

    PubMed Central

    Kataoka, Mikinori; Anzai, Sho; Shirasaki, Tomoaki; Ikemiyagi, Hidekazu; Fujii, Takashi; Mabuchi, Kazuhisa; Suzuki, Shinji; Yoshida, Masashi; Kawai, Takashi; Kitajima, Masaki

    2015-01-01

    Background and aims: Endoscopic submucosal dissection (ESD) was developed in Japan and has been performed on many patients with early stage esophageal cancer; however quality of life in patients with postoperative stricture is drastically decreased and repeat, periodic endoscopic balloon dilatation (EBD) is usually required over long periods. In this study, we evaluate the efficacy of short period, low dose oral prednisolone in controlling post-procedural esophageal stricture. Patients and methods: In total, 33 patients who underwent semicircular or complete circular ESD for esophageal superficial squamous cell carcinoma were included in this study. They were divided into two groups: those who underwent large-circumference ESD with no preventative treatment for stricture (ESD alone group) and those who received systemic steroid treatment for stricture (oral prednisolone group). We compared the two groups in terms of stricture rate and total number of EBD sessions. The ESD alone group underwent no preventative treatment. The oral prednisolone group started with 30?mg/day prednisolone on the second day post-ESD, and continued with a gradually tapering prednisolone dose, finally discontinuing systemic steroid administration 3 weeks later. Results: The stricture rate after ESD was significantly lower in the oral prednisolone group (3 of 17 patients; 17.6?%) than in the ESD alone group (11 of 16 patients; 68.7?%) (P?stage esophageal cancers.

  9. Comparison of air-coupled balloon esophageal and anorectal manometry catheters with solid-state esophageal manometry and water-perfused anorectal manometry catheters.

    PubMed

    Fang, John C; Hilden, Kristen; Tuteja, Ashok K; Peterson, Kathryn A

    2004-10-01

    Clinical gastrointestinal manometry studies are currently performed with multilumen water-perfused polyvinyl or strain gauge sensor solid-state catheters. A disposable catheter incorporating air-filled balloons has been developed with performance characteristics suitable for esophageal and anorectal manometry studies. Our aim was to compare esophageal and anorectal pressure measurements using this newly developed catheter with measurements obtained using standard solid-state or water-perfused catheters. Measurements of resting LES pressure, esophageal contraction amplitudes, and anorectal rest and squeeze pressures were obtained in 10 healthy volunteers using a solid-state esophageal catheter, a water-perfused anorectal catheter, and air-filled balloon esophageal and anorectal catheters. Correlation coefficient analysis demonstrated that LES pressures, esophageal contraction amplitudes, and anorectal resting and squeeze pressures were not significantly among between the different catheters. We conclude that recently developed air-filled balloon esophageal and anorectal manometry catheters provide very similar measurements of LES, esophageal body, and anorectal sphincter pressures compared to presently used manometry catheters. PMID:15573923

  10. Relationships Between Eosinophilic Inflammation, Tissue Remodeling and Fibrosis in Eosinophilic Esophagitis*

    PubMed Central

    Aceves, Seema S.; Ackerman, Steven J.

    2009-01-01

    SYNOPSIS The clinical and pathologic features of Eosinophilic Esophagitis (EE) include extensive tissue remodeling. Increasing evidence supports a key role for the eosinophil in multiple aspects of the esophageal remodeling and fibrosis seen in this allergic disease, including epithelial hyperplasia, subepithelial fibrosis, smooth muscle hyperplasia, and angiogenesis. These structural changes contribute to the endoscopic findings of esophageal thickening, luminal narrowing, furrowing, transient and fixed rings (trachealization) and stricture, as well as the clinical features of dysmotility, dysphagia and food impactions in pediatric and adult EE. This chapter reviews the clinical implications of esophageal remodeling and fibrosis in EE and discusses the possible pathogenic mechanisms inducing and regulating these responses. We focus specifically on eosinophil and cytokine interactions with the esophageal epithelium, vascular endothelium, resident fibroblasts, and smooth muscle. Current and potential therapeutic interventions are discussed that may impact the development or resolution of chronic esophageal remodeling and fibrosis in EE. PMID:19141355

  11. Various Upper Endoscopic Findings of Acute Esophageal Thermal Injury Induced by Diverse Food: A Case Series

    PubMed Central

    Lee, Yu Mi; Kim, Ji Young; Song, Hyun Jung; Koo, Hoon Sup; Song, Kyung Ho; Kim, Yong Seok; Huh, Kyu Chan

    2014-01-01

    Esophageal thermal injury caused by food has been reported to occur mostly after drinking hot liquid food, and is known to produce alternating white and red linear mucosal bands. In addition, thermal injury caused by ingestion of hot solid foods is documented to be a cause of esophageal ulcers or pseudomembranes. From January 2006 to August 2012, five patients with suspected esophageal thermal injury underwent esophagogastroduodenoscopy with biopsy. A "candy-cane" appearance was observed in one case, pseudomembrane was observed in two cases, an esophageal ulcer was observed in one case, and a friable and edematous mucosa was noted in one case. We believe that the endoscopic findings of esophageal thermal injury depend on the following factors: causative materials, amount of food consumed, exposure period, and time to endoscopy after the incident. Therefore, physicians who encounter patients with suspected esophageal thermal injury should carefully take the patient's history considering these factors. PMID:25325006

  12. Recurrent cervical esophageal stenosis after colon conduit failure: use of myocutaneous flap.

    PubMed

    Sa, Young Jo; Kim, Young Du; Kim, Chi Kyung; Park, Jong Kyung; Moon, Seok Whan

    2013-01-14

    A 53-year-old male developed cervical esophageal stenosis after esophageal bypass surgery using a right colon conduit. The esophageal bypass surgery was performed to treat multiple esophageal strictures resulting from corrosive ingestion three years prior to presentation. Although the patient underwent several endoscopic stricture dilatations after surgery, he continued to suffer from recurrent esophageal stenosis. We planned cervical patch esophagoplasty with a pedicled skin flap of sternocleidomastoid (SCM) muscle. Postoperative recovery was successful, and the patient could eat a solid meal without difficulty and has been well for 18 mo. SCM flap esophagoplasty is an easier and safer method of managing complicated and recurrent cervical esophageal strictures than other operations. PMID:23345956

  13. Esophageal blood flow in the cat. Normal distribution and effects of acid perfusion

    SciTech Connect

    Hollwarth, M.E.; Smith, M.; Kvietys, P.R.; Granger, D.N.

    1986-03-01

    The radioactive microsphere technique was used to estimate blood flow to different regions of the esophagus and to adjacent regions of the stomach before and after perfusion of the esophagus with hydrochloric acid (pH 1.5) for 5 min. Under resting conditions total blood flow, as well as blood flow to the mucosal-submucosal layer and the muscular layer, to both sphincters was significantly higher than to the esophageal body. Blood flow to the adjacent regions of the stomach was significantly higher than esophageal blood flow. Acid perfusion resulted in a large increase in total blood flow in both sphincters and the lower esophageal body. Gastric blood flow was not altered by acid perfusion. The esophageal hyperemia resulted primarily from an increase in blood flow to the muscular layer; mucosal-submucosal blood flow was increased only in the lower esophageal sphincter. The present study indicates that short periods (5 min) of gastroesophageal reflux may increase esophageal blood flow.

  14. Clinicopathological significance of wnt/?-catenin signaling pathway in esophageal squamous cell carcinoma

    PubMed Central

    Deng, Feiyan; Zhou, Keming; Cui, Wenli; Liu, Dong; Ma, Yuqing

    2015-01-01

    Background/Aim: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignant tumors. It has been reported that Wnt signaling pathway plays an important role in Esophageal Cancer progression, metastasis and invasion. However the clinicopathological significance of Wnt2, GSK3?, and ?-catenin in ESCC has been little reported. In the present study, the aim of this study was to investigate the clinicopathologic and prognosis roles of Wnt2, GSK3?, and ?-catenin in ESCC tissue. Methods: 265 ESCC samples were analyzed by immunohistochemistry using Wnt2, GSK3?, and ?-catenin antibodies. Then, correlation of Wnt2, GSK3?, and ?-catenin expression with clinicopathological features and prognosis of ESCC patients was statistically analyzed. Results: Cytoplasmic Wnt2 overexpression was detected in 55.5% (147 of 265) ESCCs, which was significantly correlated with the degree of differentiation (P = 0.031). Cytoplasmic GSK3? overexpression was detected in 7.2% (19 of 265) ESCCs, and aberrant ?-catenin expression was identified in 54.3% (144 of 265) of ESCCs. The positive rate of Wnt2 significantly increased with the malignant degree of Kazak ESCC patients. The aberrant ?-catenin expression in GSK3?-negative ESCC was significantly associated with the ethnic, tumor size, tumor location, degree of differentiation, AJCC stage, lymph node status. Furthermore, the expression of ?-catenin implicated the ethnic difference (P = 0.019). In Kaplan-Meier curve analysis, no significant correlation was observed between the expression of Wnt2, GSK3?, ?-catenin and the poor prognosis of ESCCs. Conclusion: The aberrant ?-catenin expression could be an adverse underlying factor in carcinogenesis and progression of ESCC. There was a different statistical signification for ?-catenin in Kazakhs to compare with Hans.

  15. Multidrug resistance in primary tumors and metastases in patients with esophageal squamous cell carcinoma.

    PubMed

    Qiang, Fang; Guangguo, Ren; Yongtao, Han; Dandan, Dong; Hong, Yang

    2013-10-01

    Studies have demonstrated that radical esophagectomy can significantly prolong disease-free survival and improve the survival rate of patients with T3 or T4 esophageal cancer and lymph node metastasis. Multidrug resistant cancer cells have active efflux mechanisms that prevent the accumulation of chemotherapeutic drugs in the cells. The purpose of this study was to compare the expression of five MDR related proteins between primary tumors in patients with thoracic esophageal squamous cell carcinoma (ESCC) and metastatic cancer in lymph nodes to explore the clinical significance of heterogeneity in MDR metastatic cancer cells. Fifty-four patients with ESCC and lymph node metastasis were included. All patients underwent subtotal esophagectomy and D2/D3 lymph node resection. The expression of lung resistance-related protein (LRP), P-glycoprotein, topoisomerase-II, thymidylate synthase, and glutathione S-transferase P1-1 (GST-?) were determined in the primary tumors and lymph nodes via immunohistochemistry. The expression of LRP was significantly different between the primary tumors and lymph nodes (P = 0.026). No significant differences were found for the other four proteins, and protein expression was not associated with either degree of differentiation or disease stage. It was also found that GST-? was expressed in all patients in both the primary tumors and lymph nodes, suggesting that the design and application of chemotherapeutic protocols capable of reducing GST-? expression may be beneficial for patients with ESCC. Additional research regarding the clinical utility of MDR protein expression in ESCC is warranted to design effective chemotherapeutic protocols. PMID:23508648

  16. Original Article The Frequency of Lymphocytic and Reflux Esophagitis in Non-Human Primates

    Microsoft Academic Search

    Carlos A. Rubio; Edward J. Dick Jr; Abiel Orrego; Gene B. Hubbard

    We previously reported in humans a novel histologic phenotype of non-gastro-esophageal reflux disease called lymphocytic esophagitis. In this work, the esophagi of 121 non-human primates (103 baboons and 18 macaques) were investigated. 45 baboons (43.7%) and 9 macaques (50%) had lymphocytic esophagitis. The lymphocytic infiltration in the squamous epithelium involved not only papillary but also inter-papillary fields. Microscopic examination around

  17. Co-Infection with Paracoccidioidomycosis and Human Immunodeficiency Virus: Report of a Case with Esophageal Involvement

    PubMed Central

    Brunaldi, Mariângela O.; Rezende, Rosamar E. F.; Zucoloto, Sérgio; Garcia, Sérgio B.; Módena, José L. P.; Machado, Alcyone A.

    2010-01-01

    Paracoccidioiodomycosis (PCM) is a systemic and deep mycosis endemic in Latin America, especially in Brazil. In patients infected with human immunodeficiency virus (HIV), PCM can manifest with prominent involvement of the reticuloendothelial system. There are no reports in the literature of esophageal involvement by PCM in that population. We report a case of PCM with pulmonary and esophageal involvement without radiologic evidence of an esophageal-bronchial fistula in an HIV-infected patient. PMID:20519606

  18. Co-infection with paracoccidioidomycosis and human immunodeficiency virus: report of a case with esophageal involvement.

    PubMed

    Brunaldi, Mariângela O; Rezende, Rosamar E F; Zucoloto, Sérgio; Garcia, Sérgio B; Módena, José L P; Machado, Alcyone A

    2010-06-01

    Paracoccidioiodomycosis (PCM) is a systemic and deep mycosis endemic in Latin America, especially in Brazil. In patients infected with human immunodeficiency virus (HIV), PCM can manifest with prominent involvement of the reticuloendothelial system. There are no reports in the literature of esophageal involvement by PCM in that population. We report a case of PCM with pulmonary and esophageal involvement without radiologic evidence of an esophageal-bronchial fistula in an HIV-infected patient. PMID:20519606

  19. Effect of Freeze-Dried Berries on the Development of Reflux-Induced Esophageal Adenocarcinoma

    Microsoft Academic Search

    Harini S. Aiyer; Yan Li; Jack N. Losso; Chenfei Gao; Suzanne C. Schiffman; Stephen P. Slone; Robert C. G. Martin

    2011-01-01

    The incidence of esophageal adenocarcinoma in humans is increasing more rapidly than any other malignancy in the United States. Animal studies have demonstrated the efficacy of freeze-dried berry supplementation on carcinogen-induced esophageal squamous cell carcinoma in rats; however, no such studies have been done in esophagoduodenal anastomosis (EDA), an animal model for reflux-induced esophageal adenocarcinoma (EAC) development. Eight-week-old male Sprague-Dawley

  20. Fluconazole compared with endoscopy for human immunodeficiency virus- infected patients with esophageal symptoms

    Microsoft Academic Search

    CM Wilcox; LN Alexander; WS Clark; SE Thompson

    1996-01-01

    BACKGROUND & AIMS: The best initial treatment of human immunodeficiency virus (HIV)-infected patients with esophageal symptoms is unknown. The outcome, including safety and cost-effectiveness, of fluconazole compared with endoscopy as a treatment strategy for HIV-infected patients with new-onset esophageal symptoms was evaluated. METHODS: During a 53-month period, 134 HIV-infected patients with esophageal symptoms were randomized prospectively to groups receiving either

  1. Relevance of N-nitrosamines to esophageal cancer in China

    SciTech Connect

    Lu, S.H.; Montesano, R.; Zhang, M.S.; Feng, L.; Luo, F.J.; Chui, S.X.; Umbenhauer, D.; Saffhill, R.; Rajewsky, M.F.

    1986-01-01

    Studies on the relevance of the N-nitrosamines to esophageal cancer in China are reviewed. Although a causal association between nitrosamines exposure and esophageal cancer in China has not yet been rigorously established, exposure of Lin-Xian subjects to nitrosamines either directly or as a result of their in vivo formation has been detected in our study. Several N-nitrosamines (NDMA, NDEA, NMBzA, NPyr, NPip, and NSAR) in gastric juice collected from Lin-Xian inhabitants have been detected. A correlation was found between the lesions of esophageal epithelium and the amount of nitrosamines present. In addition, the amounts of N-nitrosamino acids excreted in 24-hr urine of subjects in Lin-Xian were significantly higher than those in Fan-Xian, indicating a higher exposure to N-nitroso compound and their precursors of the inhabitants in the high-risk area. The effect of nitrosamines on human esophagus has been investigated at the cellular levels. The amounts of O/sup 6/-MedG in DNA of esophageal or stomach mucosa of patients from Lin-Xian were higher than that from Europe. The presence of O/sup 6/-MedG in the human fetal esophagus cultured with NMBzA was also detected. These findings indicate that the elevated levels of O/sup 6/-MedG in esophageal DNA could be the result of a recent exposure to N-nitroso compounds or a genetically determined reduced cellular capacity for repair of O/sup 6/-MedG from DNA. The hyperplasia was induced in the esophagus of human fetus that cultured with NMBzA for 2 weeks to 2 months. The intervention studies of esophageal cancer in Lin-Xian have been pursued. Intake of moderate doses of ascorbic acids by Lin-Xian subjects effectively reduced the urinary levels of N-nitrosamino acids to those found in undosed subjects in the low-risk area.

  2. Amiloride and guggulsterone suppression of esophageal cancer cell growth in vitro and in nude mouse xenografts

    PubMed Central

    GUAN, Baoxiang; HOQUE, Ashraful; XU, Xiaochun

    2014-01-01

    Esophageal adenocarcinoma is increasing in the US and Western countries and frequent gastresophageal reflux or gastresophageal reflux disease carrying gastric acid and bile acid could contribute to esophageal adenocarcinogenesis. This study was designed to detect the expression of gastric acid-inducing gene Na + /H + exchanger-1 (NHE-1) ex vivo and then to explore targeting of NHE-1 expression or activity to control esophageal cancer cell viability in vitro and in nude mouse xenografts. The data showed that NHE-1 was highly expressed in esophageal adenocarcinoma tissues (66 of 101 cases [65.3%], but not in normal esophageal squamous cell epithelium (1 of 26 cases [3.8%]). Knockdown of NHE-1 expression using NHE-1 shRNA or inhibition of NHE-1 activity using the NHE-1 inhibitor amiloride suppressed viability and induced apoptosis in esophageal cancer cells. Molecularly, amiloride inhibited expression of cyclooxygenase-2 and matrix metallopeptidase-9 but not NHE-1 mRNA in esophageal cancer cells. A combination of amiloride and guggulsterone (a natural bile acid receptor inhibitor) showed more than additive effects in suppressing esophageal cancer cell growth in vitro and in nude mouse xenografts. This study suggests that inhibition of NHE-1 expression or activity or combination of amiloride and guggulsterone could be useful in control of esophageal adenocarcinoma. PMID:24999355

  3. Right atrial invasion by metastatic esophageal adenocarcinoma with direct connection to liver.

    PubMed

    Nomani, Ali Zohair; Toori, Kaleem Ullah

    2014-05-01

    Common causes of right sided intra-cardiac atrial masses include primary cardiac tumors (atrial myxoma), atrial thrombus, tumor thrombus with hepatocellular or other thoracoabdominal cancers and metastatic lesions. Invasion of atria by gastrointestinal tumors is rare and that with esophageal ones seldom observed. Esophageal cancers rather present with dysphagia, odynophagia or systemic symptoms. Due to the lack of a serosal layer, esophageal tumors usually spread early in their course. Typical sites of spread include liver, gut, mediastinum, lungs and draining lymph nodes. We report a case of metastatic esophageal adenocarcinoma presenting with direct extension of metastatic tumor thrombus from liver to right atrium via inferior vena cava. PMID:24906258

  4. Sudden death of an alcoholic elderly man with acute esophageal necrosis (black esophagus).

    PubMed

    Unuma, Kana; Harada, Kazuki; Funakoshi, Takeshi; Uemura, Koichi

    2011-10-10

    We report a fatal case of acute esophageal necrosis (black esophagus) in an elderly male with alcohol abuse who was found dead with coffee-ground vomiting. A postmortem examination revealed severe anemia and marked black coloring of the esophagus from the upper to the bottom end. This was accompanied by histologic evidence of extensive mucosal necrosis. Alcohol abuse and esophagitis-related vomiting were both considered to be factors that led to the acute fatal esophageal necrosis. The cause of death was undetermined. We discuss the possible role of acute esophageal necrosis in the cause of sudden death. PMID:21684699

  5. Esophagitis, Treatment-Related Toxicity in Non-Small Cell Lung Cancer

    PubMed Central

    Bar-Ad, Voichita; Ohri, Nitin; Werner-Wasik, Maria

    2013-01-01

    Objectives Radiation esophagitis represents a significant complication experienced by non-small cell cancer (NSCLC) patients receiving thoracic irradiation. The objective of the current review was to assess the clinical and dosimetrical parameters that may predict radiation esophagitis. Methods Studies were identified by searching PubMed electronic databases. Both prospective and retrospective studies were included. Information regarding clinical and dosimetrical parameters predicting for radiation-induced esophagitis was extracted and analyzed. Results The esophageal clinical and dosimetric parameters that best predict acute esophagitis remain unclear. In many reports, Vx (the volume of esophagus receiving x Gy) stands out, with values of x ranging from 20–70 Gy. Other studies conclude that the maximal dose received by any point of the esophagus is the best predictor of esophagitis. Another metric implicated with esophageal toxicity in some reports is the proportion of the esophageal circumference or surface area that receives high doses of radiation. Conclusions Technological advancements in patient immobilization, setup verification, and radiotherapy delivery are increasingly being employed to limit the toxicity of thoracic irradiation. Future efforts are required to determine how these complex techniques should best be implemented to minimize the risks of acute and long-term esophageal injury. PMID:21864251

  6. A comparative study of nitrite reduction by synthetic and biogenic Fe(II-III) hydroxysalts green rusts: Evidence for hydroxyl-nitrite green rust formation as an intermediate reaction product.

    NASA Astrophysics Data System (ADS)

    Ona-Nguema, G.; Guerbois, D.; Morin, G.; Zhang, Y.; Noel, V.; Brest, J.

    2013-12-01

    The occurrence of high nitrite concentrations as a result of anthropogenic activities is an important water quality concern as it is highly toxic to human and fauna, and it is used as a nitrogen source for the assimilation process. The toxicity of nitrite is related to its transformation into carcinogenic N-nitroso compounds, which are suspected to be responsible for some gastric cancers, and to its ability to convert the hemoglobin to methaemoglobin what is then unable to fix oxygen and to transport it to the tissues, involving hypoxia and the blue-baby syndrome [1]. To reduce the adverse effect of nitrite on human health and on macroalgal blooms, any process enhancing the transformation of nitrite ions to nitrogen gas is of interest for the remediation of natural environments. To achieve this purpose the use of processes involving Fe(II)-containing minerals could be considered as one of the best options. Green-rusts are mixed Fe(II-III) layered double hydroxides commonly found in anoxic zones of natural environments such as sediments and hydromorphic soils. In such anoxic environments, green rust minerals play an important role in the biogeochemical redox cycling of iron and nitrogen, and can affect the speciation and mobility of many organic and inorganic contaminants. The present study investigates the reduction of nitrite by two synthetic and two biogenic green rusts. On the one hand, Fe(II-III) hydroxychloride and Fe(II-III) hydroxycarbonate green rusts were used as synthetic interlayer forms of GR, which are referred to as ';syn-GR(CO3)' and ';syn-GR(Cl)', respectively. On the other hand, the study was performed with biogenic Fe(II-III) hydroxycarbonate green rusts obtained from the bioreduction of two ferric precursors, either Fe(III)-oxyhydroxycarbonate or lepidocrocite; these biogenic green rusts are referred to as ';bio-GR(CO3)F' and ';bio-GR(CO3)L', respectively. For synthetic green rusts, results showed that the oxidation of both syn-GR(CO3) and syn-GR(Cl) led to the reduction of nitrite ions to ammonium, and that the production of ammonium depended on their Fe(II) content. XRD patterns indicated that both synthetic green rusts were fully oxidized into magnetite during the reaction with nitrite. For biogenic green rusts, the study revealed that both bio-GR(CO3)F and bio-GR(CO3)L were capable of reducing nitrite ions without ammonium production, suggesting the conversion of nitrite ions to nitrogen gas. Moreover, we provided evidence for the first time that the interactions of bio-GR(CO3)F with nitrite led to the formation of an hydroxy-nitrite green rust as a result of the incorporation of nitrite in the interlayer region of bio-GR(CO3)F; such an intercalation of nitrite ions was not observed in experiments with bio-GR(CO3)L. XRD analysis indicated that GR(NO2) was formed as an intermediate reaction product prior to the fully oxidation of GR to ferric oxyhydroxides. [1] Philips S., Laanbroek H. J. and Verstraete W. (2002). Rev. Environ. Sci. Biotechnol. 1, 115-141.

  7. BMP-driven NRF2 activation in esophageal basal cell differentiation and eosinophilic esophagitis

    PubMed Central

    Jiang, Ming; Ku, Wei-Yao; Zhou, Zhongren; Dellon, Evan S.; Falk, Gary W.; Nakagawa, Hiroshi; Wang, Mei-Lun; Liu, Kuancan; Wang, Jun; Katzka, David A.; Peters, Jeffrey H.; Lan, Xiaopeng; Que, Jianwen

    2015-01-01

    Tissue homeostasis requires balanced self-renewal and differentiation of stem/progenitor cells, especially in tissues that are constantly replenished like the esophagus. Disruption of this balance is associated with pathological conditions, including eosinophilic esophagitis (EoE), in which basal progenitor cells become hyperplastic upon proinflammatory stimulation. However, how basal cells respond to the inflammatory environment at the molecular level remains undetermined. We previously reported that the bone morphogenetic protein (BMP) signaling pathway is critical for epithelial morphogenesis in the embryonic esophagus. Here, we address how this pathway regulates tissue homeostasis and EoE development in the adult esophagus. BMP signaling was specifically activated in differentiated squamous epithelium, but not in basal progenitor cells, which express the BMP antagonist follistatin. Previous reports indicate that increased BMP activity promotes Barrett’s intestinal differentiation; however, in mice, basal progenitor cell–specific expression of constitutively active BMP promoted squamous differentiation. Moreover, BMP activation increased intracellular ROS levels, initiating an NRF2-mediated oxidative response during basal progenitor cell differentiation. In both a mouse EoE model and human biopsies, reduced squamous differentiation was associated with high levels of follistatin and disrupted BMP/NRF2 pathways. We therefore propose a model in which normal squamous differentiation of basal progenitor cells is mediated by BMP-driven NRF2 activation and basal cell hyperplasia is promoted by disruption of BMP signaling in EoE. PMID:25774506

  8. Personalized targeted therapy for esophageal squamous cell carcinoma

    PubMed Central

    Kang, Xiaozheng; Chen, Keneng; Li, Yicheng; Li, Jianying; D'Amico, Thomas A; Chen, Xiaoxin

    2015-01-01

    Esophageal squamous cell carcinoma continues to heavily burden clinicians worldwide. Researchers have discovered the genomic landscape of esophageal squamous cell carcinoma, which holds promise for an era of personalized oncology care. One of the most pressing problems facing this issue is to improve the understanding of the newly available genomic data, and identify the driver-gene mutations, pathways, and networks. The emergence of a legion of novel targeted agents has generated much hope and hype regarding more potent treatment regimens, but the accuracy of drug selection is still arguable. Other problems, such as cancer heterogeneity, drug resistance, exceptional responders, and side effects, have to be surmounted. Evolving topics in personalized oncology, such as interpretation of genomics data, issues in targeted therapy, research approaches for targeted therapy, and future perspectives, will be discussed in this editorial.

  9. Ulcer in the basis of Zenker's diverticulum mimicking esophageal malignancy.

    PubMed Central

    Odemis, Bolent; Ataseven, Hilmi; Basar, Omer; Ertugrul, Ibrahim; Yüksel, Osman; Turhan, Nesrin

    2006-01-01

    Complications of Zenker's diverticulum are rare and include ulcer, bleeding and malignancy. Ulcer in the basis of diverticulum is a very rare complication and to date only four cases have been reported in the literature. Herein, we report a new case of ulcer in Zenker's diverticulum mimicking esophageal malignancy presumed to be due to aspirin and/or alcohol consumption. The exact diagnosis was troublesome and needed to perform diagnostic procedures repeatedly. The patient underwent external pharyngoesophageal diverticulectomy. We emphasize that endoscope should be withdrawn if any resistance is encountered during esophageal intubation-even with forward-viewing endoscope-especially when there is a Zenker's diverticulum suspicion and the patient receives ulcerogenic agents. Endoscopic examination should be performed prior to any definitive surgical procedure in all patients with Zenker's diverticulum. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:16895291

  10. [Esophageal Cancer Initially Presenting as Severe Paraneoplastic Hypercalcemia Requiring Hemodialysis].

    PubMed

    Ahn, Hye Shin; Yun, Jong Min; Lee, Yeong Bok; Ko, Yu Mi; Lee, Jung Eun; Won, Hye Sung; Kim, Sung Soo; Kim, Young Ok

    2015-06-25

    Paraneoplastic hypercalcemia without bone metastasis occurs rarely in esophageal cancer. A 75-year-old man was admitted for general weakness and lethargy. Laboratory data showed high serum calcium level (corrected calcium 14.6 mg/dL), low parathyroid hormone level (3.3 pg/mL) and high parathyroid hormone-related peptide level (3.5 pmol/L). Esophagogastroscopy showed a malignant tumor in the esophagus. Histology showed moderately differentiated squamous cell carcinoma. Bone scan showed no evidence of bone metastasis. Since the patient's calcium levels remained high and mental state did not show improvement despite intravenous fluid therapy, diuretics and intravenous bisphosphonate, hemodialysis was started. After hemodialysis treatment, the serum calcium level subsequently normalized and his mental status improved. Herein, we report a rare case of paraneoplastic hypercalcemia in a patient with esophageal cancer. PMID:26087691

  11. Mast cell density in cardio-esophageal mucosa.

    PubMed

    Mahjoub, Fatemeh E; Asefi, Hoda; Farahmand, Fatemeh; Pourpak, Zahra; Amini, Zahra

    2014-12-01

    Mast cells are related to certain gastrointestinal complaints. Mast cell density has not been studied in cardio-esophageal region to the best of our knowledge. In this study we wanted to obtain an estimate of mast cell density in this region and compare it with mast cell density in antrum. From April 2007 till March 2010, we chose children (<14 years old) who underwent upper endoscopy and from whom the taken biopsy was stated to be from lower third of esophagus, but in microscopic examination either cardio- esophageal mucosa or only cardiac mucosa was seen. Mast cells were counted by Giemsa stain at ×1000 magnification in 10 fields. 71 children (<14 years old) were included in this study of which, 63.4% (n=45) were female and 36.6% (n=26) were male. The mean age of patients was 7.20±4.21 years (range: 0.2 -14 years). The most common clinical manifestations were recurrent abdominal pain (64.8%) and vomiting (23.9%) followed by symptoms of gastro-esophageal reflux disorder, poor weight gain, hematemesis and dysphagia. The mean mast cell density in the cardiac mucosa was 33.41±32.75 in 0.25 mm2 (range: 0-155), which was two times of that in antral mucosa. We found a significant but weak positive correlation at the 0.05 level between mast cell density of cardiac mucosa and the antrum. Higher mast cell counts were seen in cardiac mucosa in this study. Significant positive correlation between mast cell density of cardiac mucosa and the antrum could hint to a single underlying etiology for the inflammatory process in gastro- esophageal junction and gastric mucosa. PMID:25148804

  12. Exploring the role of mast cells in eosinophilic esophagitis.

    PubMed

    Wershil, Barry K

    2009-02-01

    The mast cell plays a critical role in allergic responses in the gastrointestinal tract and other sites. Emerging evidence indicates that mast cells also participate in the pathogenesis of eosinophilic esophagitis, although their precise role has not been defined. This article reviews the biology of mast cells and examines the potential involvement of the cell as an effector of the inflammatory response and tissue remodeling, and as a cell that has the potential to function as an immunomodulator and limit inflammation. PMID:19141354

  13. Mate Drinking, Alcohol, Tobacco, Diet, and Esophageal Cancer in Uruguay

    Microsoft Academic Search

    eduardo De Stefani; Nubia Munoz; Jacques Esteve; Alberto Vasallo; Cesar G. Victora; Sibylle Teuchmann

    1990-01-01

    Acase-control study was conducted in Uruguay-to investigate the role of mate drinking; alcohol, tobacco, and certain dietary factors in the etiology of esophageal cancer. The study included 261 patients with squamous cell carcinoma of the esophagus and 522 hospital controls matched by sex and age. A strong association with a clear dose-response relationship was observed with the amount of mate

  14. Inhibitory motor neurons of the esophageal myenteric plexus are mechanosensitive.

    PubMed

    Dong, Hui; Jiang, Yanfen; Dong, Jane; Mittal, Ravinder K

    2015-03-01

    Mechanosensitivity of enteric neurons has been reported in the small intestine and colon, but not in the esophagus. Our earlier in vivo studies show that mechanical stretch of the esophagus in the axial direction induces neurally mediated relaxation of the lower esophageal sphincter, possibly through mechanosensitive motor neurons. However, this novel notion that the motor neurons are mechanosensitive has not been examined in isolated esophageal myenteric motor neurons. The goal of our present study was to examine the mechanosensitivity of esophageal motor neurons in primary culture and elucidate the underlying molecular mechanisms. Immmunocytochemical analysis revealed that >95% cells were positive for the neuronal marker protein gene product 9.5 and that 66% of these cells costained with protein gene product 9.5 and neuronal nitric oxide (NO) synthase. Hypotonic solution induced an increase in the cytoplasm volume in all cells that was independent of extracellular Ca(2+). Hypotonic solution and mechanical stretch induced cytoplasmic free Ca(2+) signaling in ~65% of neurons in the presence, but not absence, of extracellular Ca(2+). Neurons grown on the elastic membrane responded to mechanical stretch by an increase in neuronal size and Ca(2+) signaling simultaneously. Hypotonic stretch-induced cytoplasmic free Ca(2+) signaling was not affected by extracellular Mg(2+), 5-nitro-2-(3-phenylpropylamino)benzoic acid, and nifedipine but was attenuated by 2-aminoethoxydiphenyl borate, Gd(3+), and Grammostola mechanotoxin 4, blockers of the stretch-activated ion channels. In ~57% of the neurons, hypotonic stretch also induced Ca(2+)-dependent cytoplasmic NO production, which was abolished by Grammostola mechanotoxin 4. These results prove that the esophageal inhibitory motor neurons possess a mechanosensitive property and also provide novel insights into the stretch-activated ion channel-Ca(2+)-NO signaling pathway in these neurons. PMID:25540174

  15. Investigation of cholecystokinin receptors in the human lower esophageal sphincter

    PubMed Central

    Liu, Jun-Feng; Zhang, Jian; Liu, Xin-Bo; Drew, Paul A

    2014-01-01

    AIM: To compare the binding of cholecystokinin (CCK)-8 to CCK receptors in sling and clasp fibers of the human lower esophageal sphincter. METHODS: Esophageal sling and clasp fibers were isolated from eight esophagectomy specimens, resected for squamous cell carcinoma in the upper two thirds of the esophagus, which had been maintained in oxygenated Kreb’s solution. Western blot was used to measure CCK-A and CCK-B receptor subtypes in the two muscles. A radioligand binding assay was used to determine the binding parameters of 3H-CCK-8S to the CCK receptor subtypes. The specificity of binding was determined by the addition of proglumide, which blocks the binding of CCK to both receptor subtypes. RESULTS: There was no significant difference between the sling and clasp fibers of the human lower esophageal sphincter in the amount of CCK-A [integrated optical density (IOD) value: 22.65 ± 0.642 vs 22.328 ± 1.042, P = 0.806] or CCK-B receptor protein (IOD value: 13.20 ± 0.423 vs 12.45 ± 0.294, P = 0.224) as measured by Western blot. The maximum binding of radio-labeled CCK-8S was higher in the sling fibers than in the clasp fibers (595.75 ± 3.231 cpm vs 500.000 ± 10.087 cpm, P < 0.001) and dissociation constant was lower (Kd: 1.437 ± 0.024 nmol/L vs 1.671 ± 0.024 nmol/L, P < 0.001). The IC50 of the receptor specific antagonists were lower for the CCK-A receptors than for the CCK-B (P < 0.01). CONCLUSION: CCK binding modulates the contractile function of the lower esophageal sphincter through differential binding to the CCK-A receptor on the sling and clasp fibers. PMID:24914377

  16. Posterior left atrial–esophageal relationship throughout the cardiac cycle

    Microsoft Academic Search

    Jasbir Sra; David Krum; Angela Malloy; Atul Bhatia; Ryan Cooley; Zalmen Blanck; Anwer Dhala; Alfred J. Anderson; Masood Akhtar

    2006-01-01

    Background  Radiofrequency energy delivered throughout the cardiac cycle has the potential to cause thermal injury to the esophagus if the anatomical relationship between the posterior left atrium and the esophagus changes during cardiac motion.Objective  To assess the posterior left atrial–esophageal relationship throughout the cardiac cycle.Methods  In this study, the anatomical relationship between the posterior left atrium and the esophagus was assessed throughout the

  17. Herpes simplex virus esophagitis in the immunocompetent host: an overview

    Microsoft Academic Search

    Jambunathan Ramanathan; Majed Rammouni; Joseph Baran; Riad Khatib

    2000-01-01

    OBJECTIVE:The aim of this study was to delineate the characteristics of herpes simplex virus esophagitis (HSVE) in the immunocompetent host.METHODS:The study entailed a case report and a review of relevant literature through a MEDLINE search back to 1966. All cases with documented HSVE in patients without immunosuppression were selected and their characteristics defined.RESULTS:A total of 38 cases were identified. The

  18. [Reflux esophagitis: operative procedures in the adult: gastropexy (author's transl)].

    PubMed

    Kümmerle, F; Grönniger, J

    1978-11-01

    Fundophrenicopexy is an effective procedure for repairing important mechanical parts of the LES. Pre- and postoperative measurement of pressure in 52 patients demonstrated an increase from x = 20.1 mm Hg to x = 39.25 mm Hg. Fundophrenicopexy is the more simple surgical management compared with fundoplication and is followed less frequently by complications. If anatomical conditions allow, fundophrenicopexy is preferred in surgical treatment of reflux esophagitis. PMID:732433

  19. Esophageal Irritation due to Alendronate Sodium Tablets (Possible Mechanisms)

    Microsoft Academic Search

    C. P. Peter; L. K. Handt; S. M. Smith

    1998-01-01

    Animal studies were done using an in vivo dogmodel to examine the possible mechanism for theesophageal adverse events reported with alendronatesodium tablets. These studies showed that under low pHconditions alendronate sodium can cause esophagealirritation. No esophageal irritation occurred at pH 3.5or higher where the drug exists primarily as the sodiumsalt. The animal studies also showed that alendronate sodium can exacerbate

  20. Cervical screw missing secondary to delayed esophageal fistula: case report.

    PubMed

    Cagli, Sedat; Isik, H Serdar; Zileli, Mehmet

    2009-10-01

    Although anterior surgical approaches to the cervical spine have become popular and safe in recent years, they also have some complications. We present a case of loss of an anterior cervical plate screw by the natural tracts. The patient was a 47- year-old woman who was operated on for cervical spondylotic myelopathy at another institution. Surgical interference included two levels of anterior discectomy, iliac graft placement and fixation using plate and screws. Two years later, plate dislocation and partial migration of the upper screws were observed. After 7 years the patient complained of dysphagia and she accepted removal of the osteosynthesis. Radiographical examination showed that one of the upper screws was missing and two lower screws were broken. Esophageal perforation was found during the surgery and repaired. Further progress was favourable. Complications associated with esophageal perforation may range from massive infection and death to spontaneous recovery. Erosion of the esophageal wall due to extruded bulky constructs may lead to a persistent fistula, abscess or septic diffusion. Spontaneous perforation of the esophagus and screw loss via the gastrointestinal tract make this case interesting.. PMID:19847769

  1. Engineering Stent Based Delivery System for Esophageal Cancer Using Docetaxel.

    PubMed

    Shaikh, Mohsin; Choudhury, Namita Roy; Knott, Robert; Garg, Sanjay

    2015-07-01

    Esophageal cancer patients are often diagnosed as "advanced" cases. These patients are subjected to palliative stenting using self-expanding metallic stents (SEMS) to maintain oral alimentation. Unfortunately, SEMS get reoccluded due to tumor growth, in and over the stent struts. To investigate potential solutions to this problem, docetaxel (DTX) delivery films were prepared using PurSil AL 20 (PUS), which can be used as a covering material for the SEMS. Drug-polymer miscibility and interactions were studied. Bilayer films were prepared by adhering the blank film to the DTX loaded film in order to maintain the unidirectional delivery to the esophagus. In vitro release and the local DTX delivery were studied using in vitro permeation experiments. It was found that DTX and PUS were physically and chemically compatible. The bilayer films exhibited sustained release (>30 days) and minimal DTX permeation through esophageal tissues in vitro. The rate-determining step for the DTX delivery was calculated. It was found that >0.9 fraction of rate control lies with the esophageal tissues, suggesting that DTX delivery can be sustained for longer periods compared to the in vitro release observed. Thus, the bilayer films can be developed as a localized sustained delivery system in combination with the stent. PMID:25936529

  2. [Hyperfractionated radiotherapy with concurrent chemotherapy for advanced esophageal cancer].

    PubMed

    Asakura, Hirofumi; Takashima, Hitoshi; Yokoe, Koiku; Togami, Taro; Mitani, Masahiro; Kiuchi, Takaaki; Hosokawa, Nobuyuki; Seo, Hiroyuki; Ohkawa, Motoomi

    2005-09-01

    The clinical efficacy and safety of hyperfractionated radiotherapy with concurrent chemotherapy were studied retrospectively in patients with primary advanced esophageal cancer. The subjects were 31 patients who were treated with hyperfractionated radiotherapy and concurrent chemotherapy in our institution between 1990 and 2001. The chemoradiotherapy consisted of cisplatin 70-80 mg/m2 on day one, and continuous infusion of 5-fluorouracil 700-800 mg/m2/24 hours on days 1 to 3, with concurrent hyperfractionated radiotherapy (57.6-72 Gy). Complete remission (CR) was observed in 17 cases, and partial response in 13 cases (response rate: 96. 7%). Three-year survival rate and 5-year survival rate were 35.5% and 26.3%, respectively. Grade 3/4 hematological toxicities included leukocytes in 7 patients (22.6%), hemoglobin in 6 patients (19.4%), and platelets in 4 patients (12.9%). Grade 3 dysphagia-esophageal related to radiation was observed in 3 patients (9.7%). Late toxicities occurred with the following incidences: hypothyroidism in 2 patients, benign esophageal strictures in 2 patients, pericardial effusion in 8 patients, and pleural effusion in 8 patients. The results suggest that combined chemotherapy and hyperfractionated radiotherapy is an effective and well-tolerated regimen. PMID:16184924

  3. Prognostic significance of phosphorylated RON in esophageal squamous cell carcinoma.

    PubMed

    Hui, Marco K C; Lai, Kenneth K Y; Chan, Kwok Wah; Luk, John M; Lee, Nikki P; Chung, Yvonne; Cheung, Leo C; Srivastava, Gopesh; Tsao, Sai Wah; Tang, Johnny C; Law, Simon

    2012-09-01

    Esophageal squamous cell carcinoma (ESCC) is the most common type of esophageal cancer. RON is a transmembrane receptor overexpressed in various cancers; however, the clinical significance of its phosphorylated form (pRON) is not fully deciphered. This report is the first to investigate the expression and clinical significance of pRON in human ESCC. Quantitative polymerase chain reaction revealed an up-regulation of RON mRNA in 70% (7/10) of ESCC tissues when compared to the adjacent nontumor tissues. An overexpression of pRON protein was found in most of the ESCC cell lines studied (4/5) when compared to two non-neoplastic esophageal epithelial cells using immunoblot. In 64 ESCC tissues, pRON was localized at the cell membrane, cytoplasm and nucleus in 15 (23.4%), 63 (98.4%) and 61 (95.3%) cases using immunohistochemistry. Patients having high expression of cytoplasmic pRON significantly associated with shorter median survival when compared to those with low expression (25.41 months vs. 14.43 months), suggesting cytoplasmic pRON as a potential marker for poor prognosis in ESCC patients. PMID:22086736

  4. Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry

    Microsoft Academic Search

    Sabite Kacar; Selma Uysal; Sedef Kuran; Ulku Dagli; Yasemin Ozin; Erdem Karabulut

    AIM: To determine the gastroesophageal refl uxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) fi ndings (anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)); to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the

  5. Sitting and Supine Esophageal Pressures in Overweight and Obese Subjects Authors

    PubMed Central

    Owens, Robert L.; Campana, Lisa M.; Hess, Lauren; Eckert, Danny J.; Loring, Stephen H.; Malhotra, Atul

    2012-01-01

    Esophageal pressure can be used to approximate pleural pressure and might be clinically useful, particularly in the obese e.g to guide mechanical ventilator settings in critical illness. However, mediastinal artifact (the difference between true pleural pressure and esophageal pressure) may limit acceptance of the measurement, and reproducibility of esophageal pressure measurements remains unknown. Therefore, we aimed to assess the effect of body posture on esophageal pressure in a cohort of obese but healthy subjects, some of whom had multiple measurements, to address the clinical robustness of esophageal manometry. Twenty-five overweight and obese subjects (BMI>25kg/m2) and 11 control lean subjects (BMI<25kg/m2) underwent esophageal manometry with pressures measured seated and supine. Twenty overweight and obese subjects had measurements repeated after ~1-2 weeks. Anthropometric data and sitting and supine spirometry were recorded. The average end-expiratory esophageal pressures sitting and supine were greater in the overweight and obese group than the lean group (sitting ?0.1±2.1 vs. ?3.3±1.2cmH2O, supine 9.3±3.3 vs. 6.9±2.8cmH2O, respectively). The mean differences between repeated measurements were small (?0.3 ± 1.7cmH2O sitting and ?0.1 ± 1.5cmH2O supine). Esophageal pressures correlated with a number of anthropometric and spirometric variables. In conclusion, esophageal pressures are slightly greater in overweight and obese subjects than lean subjects; but changes with position are similar in both groups. These data indicate that mediastinal weight and postural effects on esophageal pressure are within a clinically acceptable range, and suggest that esophageal manometry can be used to inform clinical decision making across wide range of body types. PMID:22695479

  6. Activin A expression in esophageal carcinoma and its association with tumor aggressiveness and differentiation

    PubMed Central

    WANG, ZHENHUA; ZHANG, NING; SONG, RUIFENG; FAN, RUITAI; YANG, LIUQIN; WU, LIPING

    2015-01-01

    The aim of the present study was to investigate the expression of activin A in esophageal carcinoma and its association with tumor differentiation and metastasis. A total of 57 esophageal carcinoma patients and 36 controls were included in the current study. The mRNA and protein expression levels of activin A in esophageal tumors or normal esophageal tissues were determined by reverse transcription-quantitative polymerase chain reaction and immunohistochemical analysis. In addition, the association of activin A expression with esophageal carcinoma differentiation, metastasis and recurrence postoperatively was analyzed. The mRNA and protein expression levels of activin A in esophageal carcinoma were significantly higher compared with those in normal esophageal tissues (P<0.05). The expression of activin A was higher in poorly-/moderately-differentiated esophageal tumor tissues compared with that of well-differentiated or control tissues (P<0.05). Furthermore, the expression of activin A in poorly-differentiated esophageal tumor tissues was higher compared with that of moderately-differentiated tissues (P<0.05). A positive correlation was also observed between differentiation degree and activin A expression. The expression of activin A was higher in patients with lymph node metastasis compared with those without metastasis (P<0.05). The cumulative survival rate of patients with a high expression of activin A at 1, 2 and 3 years postoperatively was significantly decreased compared with that of patients with a lower expression of activin A (P<0.05); by contrast, the cumulative recurrence rate was significantly higher in patients with a lower activin A expression (P<0.05). In conclusion, abnormal expression of activin A was detected in esophageal tumor tissues, which was correlated with the tumor differentiation, metastasis, survival and recurrence. In conclusion, activin A may be used as an auxiliary index in the diagnosis and prognosis of clinical esophageal carcinoma.

  7. Effect of endoscopic submucosal dissection for superficial esophageal neoplasms and risk factors for postoperative stricture.

    PubMed

    Funakawa, Keita; Uto, Hirofumi; Sasaki, Fumisato; Nasu, Yuichiro; Mawatari, Seiichi; Arima, Shiho; Nakazawa, Junichi; Taguchi, Hiroki; Hashimoto, Shinichi; Kanmura, Shuji; Setoyama, Hitoshi; Numata, Masatsugu; Tsubouchi, Hirohito; Ido, Akio

    2015-01-01

    Endoscopic submucosal dissection (ESD) enables wider tumor resection compared with endoscopic mucosal resection and en bloc resection of superficial esophageal neoplasms. However, ESD may cause difficult-to-treat stricture of the esophagus, and therefore, prediction of and measures against postoperative esophageal stricture are critical. The aim of this study was to evaluate the effect of ESD on superficial esophageal neoplasms and identify risk factors associated with esophageal stricture after ESD.This study included 165 lesions in 120 patients with superficial esophageal neoplasms, including cancer and neoplasia, who underwent ESD from 2009 to 2013.The complete resection rate of superficial esophageal neoplasms by ESD was 90.9%. After ESD, 22 subjects (18.3%) had symptomatic esophageal stricture, 12 (10.0%) had aspiration pneumonia of grade 2, and 7 (5.8%) had mediastinal emphysema of grade 2. Comparison of the 22 subjects with stricture with the 98 subjects without stricture showed significant differences in the rate of resection of >75% of the esophageal circumference, rate of whole circumference resection, and the required time for resection. The tumor size and the size of the resected tissue sample also differed between the 2 groups. The groups did not differ in age, sex, alcohol intake, and smoking; location, macroscopic, and histological tumor findings; chest pain; or use of anticoagulants for comorbidities. In multivariate analysis, tumor size and whole circumference resection were independent risk factors for stricture. Furthermore, in 45 subjects with resection of >75% of the esophageal circumference, whole resection of the esophagus was the only independent risk factor for stricture.This study suggests that ESD has a strong therapeutic effect on superficial esophageal neoplasms; however, a greater extent of resection of the esophagus increases the risk of postoperative esophageal stricture. Preventive measures against development of postoperative stricture require further study. PMID:25569662

  8. Irritable Bowel Syndrome Is Associated With Gastroesophageal Reflux Symptom but Not Erosive Esophagitis

    PubMed Central

    Ryu, Kum Hei; Park, Bum Joon

    2013-01-01

    Background/Aims Although several studies have suggested overlaps between gastroesophageal reflux symptom and irritable bowel syndrome (IBS), the studies for the association between erosive esophagitis and IBS are rare. The aim of this study was to evaluate the association among IBS, non-erosive reflux disease (NERD), and erosive esophagitis. Methods A total of 2,769 participants completed questionnaires and underwent esophagogastroduodenoscopy and colonoscopy. IBS was diagnosed by Rome III; NERD was defined as heartburn or acid regurgitation occurring at least once per week without erosive esophagitis. Erosive esophagitis was defined by Los Angeles classification. Psychological distress was evaluated with modified 4 dimensions from revised Hopkins symptom checklist 90. Results Psychological distress was associated with both IBS and NERD, but not with erosive esophagitis. IBS was associated with somatization (adjusted OR, 2.88; 95% CI, 1.55-5.36; P < 0.001), anxiety (adjusted OR, 2.82; 95% CI, 1.36-5.88; P = 0.005), and hostility (adjusted OR, 2.06; 95% CI, 1.10-3.87; P = 0.024) and NERD was associated with somatization (adjusted OR, 5.65; 95% CI, 2.92-10.98; P < 0.001) and anxiety (adjusted OR, 3.29; 95% CI, 1.47-7.34; P = 0.004). Erosive esophagitis was associated with somatization (adjusted OR, 2.69; 95% CI, 1.26-7.91; P < 0.001). Hiatal hernia and male sex were related with erosive esophagitis but not with IBS or NERD. H. pylori had an inverse relationship with erosive esophagitis, but had no association with IBS. Whereas IBS was positively associated with NERD (adjusted OR, 2.72; 95% CI, 1.84-4.03; P < 0.001), it had no association with erosive esophagitis. Conclusions IBS shared many risk factors with NERD but not with erosive esophagitis. It partially explains why IBS was associated with NERD, but not with erosive esophagitis. PMID:24199014

  9. Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy.

    PubMed

    Haefner, Matthias F; Lang, Kristin; Krug, David; Koerber, Stefan A; Uhlmann, Lorenz; Kieser, Meinhard; Debus, Juergen; Sterzing, Florian

    2015-07-01

    The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome. PMID:25907360

  10. Prognostic factors, patterns of recurrence and toxicity for patients with esophageal cancer undergoing definitive radiotherapy or chemo-radiotherapy

    PubMed Central

    Haefner, Matthias F.; Lang, Kristin; Krug, David; Koerber, Stefan A.; Uhlmann, Lorenz; Kieser, Meinhard; Debus, Juergen; Sterzing, Florian

    2015-01-01

    The aim of this study was to evaluate the effectiveness and tolerability of definitive chemo-radiation or radiotherapy alone in patients with esophageal cancer. We retrospectively analyzed the medical records of n = 238 patients with squamous cell carcinoma or adenocarcinoma of the esophagus treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2000 and 2012. Patients of all stages were included to represent actual clinical routine. We performed univariate and multivariate analysis to identify prognostic factors for overall survival (OS) and progression-free survival (PFS). Moreover, treatment-related toxicity and patterns of recurrence were assessed. Patients recieved either chemo-radiation (64%), radiotherapy plus cetuximab (10%) or radiotherapy alone (26%). In 69%, a boost was applied, resulting in a median cumulative dose of 55.8 Gy; the remaining 31% received a median total dose of 50 Gy. For the entire cohort, the median OS and PFS were 15.0 and 11.0 months, respectively. In multivariate analysis, important prognostic factors for OS and PFS were T stage (OS: P = 0.005; PFS: P = 0.006), M stage (OS: P = 0.015; PFS: P = 0.003), concomitant chemotherapy (P < 0.001) and radiation doses of >55 Gy (OS: P = 0.019; PFS: P = 0.022). Recurrences occurred predominantly as local in-field relapse or distant metastases. Toxicity was dominated by nutritional impairment (12.6% with G3/4 dysphagia) and chemo-associated side effects. Definitive chemo-radiation in patients with esophageal cancer results in survival rates comparable with surgical treatment approaches. However, local and distant recurrence considerably restrict prognosis. Further advances in radio-oncological treatment strategies are necessary for improving outcome. PMID:25907360

  11. MicroRNA-218 inhibits the proliferation and metastasis of esophageal squamous cell carcinoma cells by targeting BMI1.

    PubMed

    Wang, Ting; Chen, Tengfei; Niu, Hua; Li, Chang; Xu, Chun; Li, Yuanyuan; Huang, Rui; Zhao, Jun; Wu, Shuyan

    2015-07-01

    MicroRNAs (miRNAs or miRs) play a pivotal role in esophageal carcinogenesis either as oncogenes or as tumor suppressor genes. In the present study, we found that the expression level of miR-218 was significantly reduced in esophageal squamous cell carcinoma (ESCC) tissues and ESCC cell lines. Moreover, its expression was found to correlate with the clinicopathological stage of ESCC; miR-218 expression was lower in the stage III tissue samples than in the stage I and II tissue samples. Furthermore, the decreased expression of miR-218 was found to be associated with an enhanced ESCC cell proliferation and metastasis. Western blot analysis and luciferase reporter assay revealed that miR-218 decreased BMI1 expression by binding to the putative binding sites in its 3'-untranslated region (3'-UTR). The BMI1 mRNA expression levels were markedly increased and negatively correlated with the miR-218 expression level in the ESCC tissues. Functional analyses revealed that the restoration of miR-218 expression inhibited ESCC cell proliferation, migration and invasion and promoted apoptosis. The knockdown of BMI1 by siRNA showed the same phenocopy as the effect of miR-218 on ESCC cells, indicating that BMI1 was a major target of miR-218. In the present study, our findings confirm miR-218 as a tumor suppressor and identify BMI1 as a novel target of miR-218 in ESCC. Therefore, miR-218 may prove to be a useful biomarker for monitoring the initiation and development of ESCC, and may thus be an effective therapeutic target in ESCC. PMID:25999024

  12. Radiation-Induced Esophagitis Masquerading as Disease Progression in Case of Esophageal Carcinoma: A Diagnostic Dilemma Solved on Follow-up FDG PET/CT.

    PubMed

    Mukherjee, Anirban; Chakraborty, Partha Sarathi; Behera, Abhishek; Bal, Chandrasekhar; Kumar, Rakesh

    2015-07-01

    Radiation esophagitis is one of the commonest complications of the radiotherapy involving esophagus. It is characterized by diffuse radiotracer uptake in the esophagus on F-FDG PET/CT. Thus, it can be often confused with the esophageal malignancy. We present the sequential F-FDG PET/CT images of a 45-year-old woman with locally advanced squamous cell carcinoma of the esophagus who developed radiation esophagitis after chemoradiotherapy. It was confused with the progression of the disease, and the dilemma was resolved by the follow-up PET/CT. PMID:25706793

  13. Heat treatment of human esophageal tissues: Effect on esophageal cancer detection using oxygenated hemoglobin diffuse reflectance ratio

    NASA Astrophysics Data System (ADS)

    Zhao, Q. L.; Guo, Z. Y.; Si, J. L.; Wei, H. J.; Yang, H. Q.; Wu, G. Y.; Xie, S. S.; Guo, X.; Zhong, H. Q.; Li, L. Q.; Li, X. Y.

    2011-03-01

    The main objective of the present work is to study the influence of heat treatment on the esophageal cancer detection using the diffuse reflectance (DR) spectral intensity ratio R540/R575 of oxygenated hemoglobin (HbO2) absorption bands to distinguish the epithelial tissues of normal human esophagus and moderately differentiated esophageal squamous cell carcinoma (ESCC) at different heat treatment temperature of 20, 37, 42, 50, and 60°C, respectively. The DR spectra for the epithelial tissues of the normal esophagus and ESCC in vitro at different heat-treatment temperature in the wavelength range 400-650 nm were measured with a commercial optical fiber spectrometer. The results indicate that the average DR spectral intensity overall enhancement with concomitant increase of heat-treatment temperature for the epithelial tissues of normal esophagus and ESCC, but the average DR spectral intensity for the normal esophageal epithelial tissues is relatively higher than that for ESCC epithelial tissues at the same heat-treatment temperature. The mean R540/R575 ratios of ESCC epithelial tissues were always lower than that of normal esophageal epithelial tissues at the same temperature, and the mean R540/R575 ratios of the epithelial tissues of the normal esophagus and ESCC were decreasing with the increase of different heat-treatment temperatures. The differences in the mean R540/R575 ratios between the epithelial tissues of normal esophagus and ESCC were 13.33, 13.59, 11.76, and 11.11% at different heat-treatment temperature of 20, 37, 42, and 50°C, respectively. These results also indicate that the DR intensity ratio R540/R575 of the hemoglobin bands is a useful tool for discrimination between the epithelial tissues of normal esophagus and ESCC in the temperature range from room temperature to 50°C, but it was non-effective at 60°C or over 60°C.

  14. Salt tea consumption and esophageal cancer: a possible role of alkaline beverages in esophageal carcinogenesis.

    PubMed

    Dar, Nazir Ahmad; Bhat, Gulzar Ahmad; Shah, Idrees Ayoub; Iqbal, Beenish; Rafiq, Rumaisa; Nabi, Sumaiya; Lone, Mohd Maqbool; Islami, Farhad; Boffetta, Paolo

    2015-03-15

    Salt tea is the most commonly used beverage in Kashmir, India, where esophageal squamous cell carcinoma (ESCC) is the most common cancer. Salt tea is brewed in a unique way in Kashmir, usually with addition of sodium bicarbonate, which makes salt tea alkaline. As little information about the association between salt tea drinking and ESCC was available, we conducted a large-scale case-control study to investigate this association in Kashmir. We recruited 703 histologically confirmed cases of ESCC and 1664 controls individually matched to cases for age, sex, and district of residence. Conditional logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). Participants who consumed >1,250 ml day(-1) showed an increased risk of ESCC (OR?=?2.60, 95% CIs?=?1.68-4.02). Samovar (a special vessel for the beverage preparation) users (OR?=?1.77, 95% CIs 1.25-2.50) and those who ate cereal paste with salt tea (OR?=?2.14, 95% CIs?=?1.55-2.94) or added bicarbonate sodium to salt tea (OR?=?2.12, 95% CIs?=?1.33-3.39) were at higher risk of ESCC than others. When analysis was limited to alkaline tea drinkers only, those who both consumed cereal paste with salt tea and used samovar vessel were at the highest risk (OR?=?4.58, 95% CIs?=?2.04-10.28). This study shows significant associations of salt tea drinking and some related habits with ESCC risk. PMID:25209106

  15. Temporary gastric banding in a premature infant with esophageal atresia and severe respiratory distress syndrome.

    PubMed

    Laeven, Nina F A; Derikx, Joep P M; van Hoorn, Jeroen H L; van Heurn, L W Ernest

    2015-04-01

    The management of premature, very low birth weight infants with esophageal atresia and tracheo-esophageal fistula complicated by respiratory insufficiency is still challenging. We present a case of a premature, very low weight infant in whom we used a technique of temporary gastric banding to control the air leak through the fistula. PMID:25630811

  16. Hospital volume is related to clinical and economic outcomes of esophageal resection in Maryland

    Microsoft Academic Search

    Justin B Dimick; Stephen M Cattaneo; Pamela A Lipsett; Peter J Pronovost; Richard F Heitmiller

    2001-01-01

    Background. Previous studies have documented a relationship between hospital volume and perioperative and economic outcomes. Our objective was to determine the effect of hospital volume on outcomes of esophageal resection.Methods. Statewide database was analyzed for patients who underwent esophageal resection in Maryland (n = 1,136 patients) from 1984 to 1999. Multivariate regression was used to determine the association of hospital

  17. [Esophageal aspergillosis in a patient with acute myelogenous leukemia and febrile neutropenia].

    PubMed

    Besa, Santiago; Kattan, Eduardo; Cid, Ximena; Claro, Juan C

    2014-04-01

    Aspergillosis usually compromises the respiratory system, but can also affect others. We report a 46 yo female with acute myeloid leukemia, developed febrile neutropenia and dysphagia. Endoscopy revealed esophageal cytomegalovirus-like ulcers, but biopsies showed Aspergillus spp. It's important to consider aspergillosis in the differential diagnosis of esophageal lesions in high-risk patients. PMID:24878914

  18. HCl-induced cell edema in rabbit esophageal epithelium: A bumetanide-sensitive process

    Microsoft Academic Search

    Nelia A. Tobey; Edward J. Cragoe; Roy C. Orlando

    1995-01-01

    Background & Aims: The morphology of acid damage to esophageal epithelium is characterized by marked cell (swelling) edema. This observation suggests that, in the process of acid damage, an increase in osmotic forces develops within the cell that accounts for the increase in cell water. The aim of this study was to document that esophageal cells swell at acidic pH

  19. Endoscopic injection sclerotherapy for esophageal varices prolonged survival of patients with hepatocellular carcinoma complicating liver cirrhosis

    Microsoft Academic Search

    Ryuichi Iwakiri; Takanori Koyama; Masahiro Hirano; Yasufumi Uchida; Sadatoshi Ishibashi; Atsuo Kuwahara; Keiji Matsunaga; Hiroyuki Sakata; Kazuma Fujimoto

    2000-01-01

    Background: A prospective controlled study was performed between 1982 and 1991 to evaluate the efficacy of endoscopic injection sclerotherapy (EIS) in patients with esophageal varices complicated by hepatocellular carcinoma and liver cirrhosis. Methods: The study included 83 patients with esophageal varices, hepatocellular carcinoma, and liver cirrhosis. Forty-three patients (group 1) underwent prophylactic EIS or emergent EIS for bleeding varices. EIS

  20. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions

    Microsoft Academic Search

    Tatsuya Yoshida; Haruhiro Inoue; Shinsuke Usui; Hitoshi Satodate; Norio Fukami; Shin-ei Kudo

    2004-01-01

    BackgroundBy assessing the intrapapillary capillary loop in esophageal mucosa, magnifying endoscopy can play an important role in the evaluation of superficial esophageal lesions. A newly developed narrow-band imaging system was applied to magnifying endoscopy in a clinical setting; the benefit of the narrow-band imaging system was evaluated.

  1. Nissen fundoplication has a vagolytic effect on the lower esophageal sphincter

    Microsoft Academic Search

    B. Sarani; T. Chan; R. Wise; S. Evans

    2003-01-01

    Background: Laparoscopic Nissen fundoplication is an increasingly utilized option for the treatment of gastroesophageal reflux disease (GERD). However, many questions remain as to the mechanism by which this operation prevents GERD in those without hiatal hernias or incompetent lower esophageal sphincters (LES). It is known that these patients experience reflux due to excess transient lower esophageal sphincter relaxations (TLESR), inappropriate

  2. MITOMYCIN C IN THE MANAGEMENT OF PEDIATRIC CAUSTIC ESOPHAGEAL STRICTURES. A CASE REPORT

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Mitomycin C (MMC) inhibits fibroblast proliferation and is effective in reducing scar in animal experiments. We report the case of a child with a distal esophageal stricture...

  3. Endoscopic dilation of esophageal stricture without fluoroscopy is safe and effective

    Microsoft Academic Search

    Yong-Guang Wang; Thian-Lok Tio; Nib Soehendra

    AIM: Endoscopic dilation of esophageal strictures is a commonly performed procedure in the management of dysphagia. The procedure is usually done with fluoroscopic guidance. The aim of this study was to assess the use of Tracer guide wire in conjunction with Savary-Gilliard dilators in the dilation of tight esophageal strictures without fluoroscopy. METHODS: Fifty-five patients with significant dysphagia from strictures

  4. Prevention of Radiochemotherapy-Induced Esophagitis With Glutamine: Results of a Pilot Study

    SciTech Connect

    Algara, Manuel [Department of Radiation Oncology, Hospital de l'Esperanca, Institut Municipal d'Assistencia Sanitaria (IMAS), Barcelona (Spain); Universitat Pompeu Fabra, Barcelona (Spain)], E-mail: malgara@imas.imim.es; Rodriguez, Nuria; Vinals, Pedro [Department of Radiation Oncology, Hospital de l'Esperanca, Institut Municipal d'Assistencia Sanitaria (IMAS), Barcelona (Spain); Lacruz, Marti [Department of Radiation Oncology, Hospital de l'Esperanca, Institut Municipal d'Assistencia Sanitaria (IMAS), Barcelona (Spain); Universitat Pompeu Fabra, Barcelona (Spain); Foro, Palmira; Reig, Anna [Department of Radiation Oncology, Hospital de l'Esperanca, Institut Municipal d'Assistencia Sanitaria (IMAS), Barcelona (Spain); Quera, Jaume [Department of Radiation Oncology, Hospital de l'Esperanca, Institut Municipal d'Assistencia Sanitaria (IMAS), Barcelona (Spain); Universitat Pompeu Fabra, Barcelona (Spain); Lozano, Joan; Fernandez-Velilla, Enric; Membrive, Ismael; Dengra, Josefa; Sanz, Xavier [Department of Radiation Oncology, Hospital de l'Esperanca, Institut Municipal d'Assistencia Sanitaria (IMAS), Barcelona (Spain)

    2007-10-01

    Purpose: To assess the usefulness of oral glutamine to prevent radiochemotherapy-induced esophagitis in patients with lung cancer, and to determine the dosimetric parameter predictive of esophagitis. Methods and Materials: Seventy-five patients were enrolled; 34.7% received sequential radiochemotherapy, and 65.3% received concomitant radiochemotherapy. Every patient received prophylactic glutamine powder in doses of 10 g/8 h. Prescribed radiation doses were 45-50 Gy to planning target volume (PTV)1 (gross tumor volume plus wide margins) and 65-70 Gy to PTV2 (reduced margins). The primary endpoint was the incidence of Grade 2 or greater acute esophagitis. Results: No patient experienced glutamine intolerance or glutamine-related toxicity. Seventy-three percent of patients who received sequential chemotherapy and 49% of those who received concomitant chemotherapy did not present any form of esophagitis. V50 was the dosimetric parameter with better correlation between esophagitis and its duration. A V50 of {<=}30% had a 22% risk of esophagitis Grade {>=}2, which increased to 71% with a V50 of >30% (p = 0.0009). Conclusions: The use of oral glutamine may have an important role in the prevention of esophageal complications of concomitant radiochemotherapy in lung cancer patients. However, randomized trials are needed to corroborate that effect. V50 is the dosimetric parameter with better correlation with esophagitis grade and duration.

  5. Localization of nitric oxide synthase in the brain stem neural circuit controlling esophageal peristalsis in rats

    Microsoft Academic Search

    Ellen Bart Wiedner; Xinmin Bao; Steven M. Altschuler

    1995-01-01

    Background\\/Aims: The central subnucleus of the nucleus of the solitary tract has been implicated in central reflex control of esophageal peristalsis. This study determined the presence of nitric oxide synthase in the brain stem circuit controlling esophageal peristalsis by combining transsynaptic retrograde tract tracing with pseudorabies virus and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH) histochemistry. Methods: Virus was injected into

  6. Current status of esophageal cancer – West versus East: the European point of view

    Microsoft Academic Search

    J. Rüdiger Siewert; Burkhard H. A. von Rahden; Hubert J. Stein

    2004-01-01

    Esophageal cancer and its treatment differ largely between the West and the East because West and East are concerned – at least in part – with different diseases: squamous cell cancers are the prevailing tumor type in Japan and other parts of Asia whereas this entity is now clearly outnumbered in Europe and North America by esophageal adenocarcinoma. The latter

  7. Impact of Preoperative Dental Plaque Culture for Predicting Postoperative Pneumonia in Esophageal Cancer Patients

    Microsoft Academic Search

    Yasunori Akutsu; Hisahiro Matsubara; Shinichi Okazumi; Hideaki Shimada; Kiyohiko Shuto; Toru Shiratori; Takenori Ochiai

    2008-01-01

    Background\\/Aims: In esophageal cancer patients, postoperative pneumonia frequently occurs. In the oral cavity, dental plaque is a major reservoir of bacteria, and it is possible that oral bacteria are aspirated into the upper respiratory tract after esophagectomy. We evaluated the interaction between preoperative dental plaque and postoperative pneumonia in patients undergoing esophagectomy. Patients and Methods: Thirty-nine patients with thoracic esophageal

  8. Esophageal and rectal temperatures as estimates of core temperature during therapeutic whole-body hypothermia.

    PubMed

    Sarkar, Subrata; Donn, Steven M; Bhagat, Indira; Dechert, Ronald E; Barks, John D

    2013-01-01

    We monitored whole-body cooling concurrently by both esophageal and rectal probes. Esophageal temperature was significantly higher compared with simultaneous rectal temperature during cooling, with a temperature gradient ranging from 0.46 to 1.03°C (median, 0.8°C; IQR, 0.6-0.8°C). During rewarming, this temperature difference disappeared. PMID:23063267

  9. Curing Helicobacter pylori infection in patients with duodenal ulcer may provoke reflux esophagitis

    Microsoft Academic Search

    J Labenz; AL Blum; E Bayerdorffer; A Meining; M Stolte; G Borsch

    1997-01-01

    BACKGROUND & AIMS: We have shown previously that cure of Helicobacter pylori infection leads to the disappearance of acid-neutralizing substances. Also, patients with ulcer after cure may gain weight. The aim of this study was to investigate whether cure of the infection increases the risk of reflux esophagitis. METHODS: Patients with duodenal ulcer without reflux esophagitis at the time of

  10. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis

    Microsoft Academic Search

    Jonathan M. Spergel; Janet L. Beausoleil; Maria Mascarenhas; Chris A. Liacouras

    2002-01-01

    Background: Eosinophilic esophagitis is a disease entity in which patients have (1) elevated eosinophils on esophageal biopsy and (2) symptoms of gastroesophageal reflux. The symptoms do not improve on aggressive acid blockade but do improve on elimination diet or corticosteroid treatment, which tentatively links food allergies to this disorder. Objective: The purpose of this study was to identify potential food

  11. Evaluation of an electronic esophageal detector device in patients with morbid obesity and pulmonary failure

    Microsoft Academic Search

    Timothy R. Wolfe; Edward J. Kimball; L. Lazarre Ogden; Pat Schafer; Stephen C. Hartsell; Scott Richardson; Matthew R. Moog; Richard Barton

    2002-01-01

    Objective. Undetected esophageal intubation can result in permanent injury or death. Clinical confirmation of tube location may be misleading. Adjunctive methods should be used to supplement clinical judgment. Unfortunately, end-tidal carbon dioxide may misidentify properly placed tracheal tubes in low perfusion situations, while esophageal detector devices (EDDs) may misidentify properly placed tracheal tubes in situations where little airway dead space

  12. Symptom relief effect of palliative high dose rate intracavitary radiotherapy for advanced esophageal cancer with dysphagia

    PubMed Central

    YAMASHITA, MAMI; YAMASHITA, HIDEOMI; SHIBATA, SHINO; OKUMA, KAE; NAKAGAWA, KEIICHI

    2015-01-01

    Intracavitary radiotherapy (ICRT) for the palliative treatment of advanced esophageal cancer with dysphagia is currently performed at the University of Tokyo Hospital (Tokyo, Japan). In the present study, 24 patients exhibiting advanced esophageal cancer with dysphagia received palliative ICRT. ICRT, which was delivered 5 mm below the esophageal mucous membrane, with the exception of one case, was administered at a dose of 6 Gy/fraction. Specific patients additionally underwent definitive or palliative external beam radiation therapy for esophageal cancer a minimum of three months prior to ICRT. The effect of treatment on symptom alleviation was examined by comparing the dysphagia score prior to and following ICRT, with the patients’ medical records and a questionnaire used to calculate a dysphagia score ranging from zero (no dysphagia) to four (total dysphagia). In consideration of the individual efficacy of the treatment, the maximum number of repeated ICRT fractions was four (median, 1.7 times). A trend in the improvement of the symptom of dysphagia was observed in response to esophageal ICRT, with the average dysphagia score markedly decreasing from 2.54 to 1.65, however, the difference was not significant (P=0.083). Furthermore, pain was the most frequent side-effect of the esophageal ICRT and no patients exhibited severe complications. Thus, esophageal ICRT at a dose of 6 Gy/fraction may present an effective strategy for relieving the symptom of dysphagia in cases of advanced esophageal cancer. PMID:25789035

  13. Mountain Stage

    NSDL National Science Digital Library

    Mountain Stage, a famous Charleston, West Virginia, venue where folk musicians play, is broadcast on National Public Radio, and can be heard on the NPR website, simply by clicking on "Listen", next to the artist's picture and brief bio. Visitors wishing to read more about the artist's musical history can click on the name of the artist next to their picture. Included in the history is their set list for the broadcast show. Visitors can comment on each artist's show, or recommend it to other visitors, by clicking on the icons at the bottom of each brief bio on the homepage.

  14. J STAGE

    NSDL National Science Digital Library

    Developed by the Japan Science and Technology Corporation (JST), J-STAGE (The Japan Science and Technology Aggregator, Electronic) is a recently launched electronic journal center that publishes and disseminates Japanese electronic scientific journals. At present, the site hosts four journals (one of which is Japanese only), but expects to add over a hundred in the near future. The three available English-language journals include the Japanese Journal of Applied Physics, the Journal of the Physical Society of Japan, and SHIGEN-TO-SOZAI, a journal of the Mining and Materials Processing Institute of Japan. The full-text articles are available free of charge with searchable back issues also available.

  15. [Long-term survival of a patient with esophageal metastasis from breast cancer treated with esophagectomy].

    PubMed

    Kawabata, Ryohei; Kimura, Yutaka; Kawase, Tomono; Kamigaki, Shunji; Yamamura, Jun; Nakamura, Yukio; Munakata, Satoru; Fukunaga, Mutsumi; Ohzato, Hiroki

    2014-11-01

    Esophageal metastasis from breast cancer is rarely observed. We encountered a case of long-term survival after esophageal metastasis from breast cancer that was treated with esophagectomy. A 79-year-old woman developed dysphagia 26 years after radical mastectomy. Endoscopic examination revealed stenosis at the mid-thoracic esophagus. An esophageal biopsy led to a diagnosis of undifferentiated cancer. A computed tomography (CT) scan revealed a massive tumor in the esophagus, but no distant metastases. Esophagectomy was performed with the suspicion of primary or metastatic esophageal cancer. Histopathologically, the excised tumor was an adenocarcinoma, which had histopathological features similar to that of the breast cancer. Accordingly, the adenocarcinoma was diagnosed as esophageal metastasis of the breast cancer. The patient is still alive 8 years after the esophagectomy. PMID:25731410

  16. Rare complication after thyroidectomy-cervical esophageal stenosis: a case report and literature review.

    PubMed

    Peng, Hanwei; Wang, Steven J; Li, Weixiong

    2014-01-01

    The most common complications after thyroidectomy are injuries associated with the recurrent laryngeal nerve and parathyroid gland. Cervical esophagus perforation is an exceptionally rare complication after thyroidectomy; it can usually be resolved by conservative care. Cervical esophageal stenosis secondary to intraoperative esophageal injury during thyroidectomy is much rarer and has not been reported in the literature to date. We report a case of esophageal stenosis following thyroidectomy performed at a peripheral hospital. The patient initially underwent a thyroidectomy for papillary thyroid carcinoma involving the cervical esophagus; esophageal perforation was noted intraoperatively, and closed using three number 4 silk sutures. Cervical esophageal stenosis subsequently developed after conservative care. The patient was successfully treated with cervical esophagectomy and reconstruction using a tubed forearm free flap after a failed attempt at endoscopic recanalization. This case is discussed in conjunction with a review of the literature. PMID:25305782

  17. Association of Esophageal Inflammation, Obesity and Gastroesophageal Reflux Disease: From FDG PET/CT Perspective

    PubMed Central

    Lee, Yi-Chia; Wang, Shan-Ying; Chiu, Han-Mo; Tu, Chia-Hung; Wang, Hsiu-Po; Lin, Jaw-Town; Wu, Ming-Shiang; Yang, Wei-Shiung

    2014-01-01

    Objective Gastroesophageal reflux disease (GERD) is associated with bothersome symptoms and neoplastic progression into Barrett's esophagus and esophageal adenocarcinoma. We aim to determine the correlation between GERD, esophageal inflammation and obesity with 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). Methods We studied 458 subjects who underwent a comprehensive health check-up, which included an upper gastrointestinal endoscopy, FDG PET/CT and complete anthropometric measures. GERD symptoms were evaluated with Reflux Disease Questionnaire. Endoscopically erosive esophagitis was scored using the Los Angeles classification system. Inflammatory activity, represented by standardized uptake values (SUVmax) of FDG at pre-determined locations of esophagus, stomach and duodenum, were compared. Association between erosive esophagitis, FDG activity and anthropometric evaluation, including body mass index (BMI), waist circumference, visceral and subcutaneous adipose tissue volumes were analyzed. Results Subjects with erosive esophagitis (n?=?178, 38.9%) had significantly higher SUVmax at middle esophagus (2.69±0.74 vs. 2.41±0.57, P<.001) and esophagogastric junction (3.10±0.89 vs. 2.38±0.57, P<.001), marginally higher at upper esophageal sphincter (2.29±0.42 vs. 2.21±0.48, P?=?.062), but not in stomach or duodenum. The severity of erosive esophagitis correlated with SUVmax and subjects with Barrett's esophagus had the highest SUVmax at middle esophagus and esophagogastric junction. Heartburn positively correlated with higher SUVmax at middle oesophagus (r?=?.262, P?=?.003). Using multivariate regression analyses, age (P?=?.027), total cholesterol level (P?=?.003), alcohol drinking (P?=?.03), subcutaneous adipose tissue (P<.001), BMI (P<.001) and waist circumference (P<.001) were independently associated with higher SUVmax at respective esophageal locations. Conclusions Esophageal inflammation demonstrated by FDG PET/CT correlates with endoscopic findings and symptomatology of GERD. Obesity markers, both visceral and general, are independent determinants of esophageal inflammation. PMID:24642729

  18. Comparison of Air-Coupled Balloon Esophageal and Anorectal Manometry Catheters with Solid-State Esophageal Manometry and Water-Perfused Anorectal Manometry Catheters

    Microsoft Academic Search

    John C. Fang; Kristen Hilden; Ashok K. Tuteja; Kathryn A. Peterson

    2004-01-01

    Clinical gastrointestinal manometry studies are currently performed with multilumen water-perfused polyvinyl or strain gauge sensor solid-state catheters. A disposable catheter incorporating air-filled balloons has been developed with performance characteristics suitable for esophageal and anorectal manometry studies. Our aim was to compare esophageal and anorectal pressure measurements using this newly developed catheter with measurements obtained using standard solid-state or water-perfused catheters.

  19. Chromosomal instability and copy number alterations in Barrett's esophagus and esophageal adenocarcinoma

    PubMed Central

    Paulson, Thomas G.; Maley, Carlo C.; Li, Xiaohong; Li, Hongzhe; Sanchez, Carissa A.; Chao, Dennis L.; Odze, Robert D.; Vaughan, Thomas L.; Blount, Patricia L.; Reid, Brian J.

    2009-01-01

    Purpose Chromosomal instability, as assessed by many techniques, including DNA content aneuploidy, LOH, and comparative genomic hybridization, has consistently been reported to be common in cancer and rare in normal tissues. Recently, a panel of chromosome instability biomarkers, including LOH and DNA content, has been reported to identify patients at high and low risk of progression from Barrett's esophagus (BE) to esophageal adenocarcinoma (EA), but required multiple platforms for implementation. Although chromosomal instability involving amplifications and deletions of chromosome regions have been observed in nearly all cancers, copy number alterations (CNAs) in premalignant tissues have not been well characterized or evaluated in cohort studies as biomarkers of cancer risk. Experimental Design We examined CNAs in 98 patients having either BE or EA using BAC array CGH to characterize CNAs at different stages of progression ranging from early BE to advanced EA. Results CNAs were rare in early stages (stages (HGD and EA), including high level amplifications. The number of CNAs correlated highly with DNA content aneuploidy. Patients whose biopsies contained CNAs involving more than 70 Mbp were at increased risk of progression to DNA content abnormalities or EA (HR=4.9, 95% CI 1.6-14.8, p=0.0047), and the risk increased as more of the genome was affected. Conclusions Genome wide analysis of CNAs provides a common platform for evaluation of chromosome instability for cancer risk assessment as well as identification of common regions of alteration that can be further studied for biomarker discovery. PMID:19417022

  20. Elevated p53 expression levels correlate with tumor progression and poor prognosis in patients exhibiting esophageal squamous cell carcinoma

    PubMed Central

    HUANG, KATE; CHEN, LIN; ZHANG, JILIANG; WU, ZHI; LAN, LINHUA; WANG, LU; LU, BIN; LIU, YONGZHANG

    2014-01-01

    Esophageal squamous cell carcinoma (ESCC) is the most common histological subtype of esophageal cancer and one of the most aggressive types of malignancy, with a high rate of mortality. Early diagnosis and treatment may improve the prognosis of ESCC and, thus, survival rates. As a significant tumor suppressor, p53 is closely associated with apoptosis and the differentiation of cancer cells. The present study evaluated the expression levels of the p53 protein and the clinical significance in patients presenting with ESCC. The p53 protein expression level of 64 paired ESCC and tumor-adjacent normal tissues was evaluated using western blot analysis. In addition, immunohistochemistry (IHC) was performed to detect the p53 expression level in specimens from 118 paraffin-embedded cancerous tissues. The correlation of the p53 expression level with the clinicopathological parameters and prognosis of the ESCC patients was also analyzed. The p53 protein was identified to be highly expressed in the ESCC tissue, with western blot analysis demonstrating that the expression level of p53 in the cancerous tissue was 1.89 times that of the tumor-adjacent normal tissue (P<0.001); furthermore, IHC indicated that there was a marked positive expression of p53 in the ESCC tissue (49.15%). The expression level of p53 protein was identified to be significantly correlated with the tumor grade (P<0.001), N stage (P=0.010). Additionally, the higher level of p53 expression was found to be associated with a poor survival rate in the ESCC patients (P=0.0404). The univariate analysis showed that the survival time of patients was significantly correlated with the T stage (RR=3.886, P<0.001), N stage (lymph node metastasis; RR=3.620, P<0.001) and TNM stage (RR=3.576, P<0.001). Furthermore, the multivariate analysis revealed that the T stage (RR=3.988, P<0.001) and N stage (RR=4.240, P=0.004) significantly influenced the overall survival of the ESCC patients. PMID:25202347

  1. Factors Affecting the Risk of Brain Metastasis in Small Cell Lung Cancer With Surgery: Is Prophylactic Cranial Irradiation Necessary for Stage I-III Disease?

    SciTech Connect

    Gong Linlin; Wang, Q.I.; Zhao Lujun; Yuan Zhiyong; Li Ruijian [Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin (China)] [Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin (China); Wang Ping, E-mail: Doctorwang66@yahoo.cn [Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, and Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin (China)

    2013-01-01

    Purpose: The use of prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC) with surgical resection has not been fully identified. This study undertook to assess the factors affecting the risk of brain metastases in patients with stage I-III SCLC after surgical resection. The implications of PCI treatment for these patients are discussed. Methods and Materials: One hundred twenty-six patients treated with surgical resection for stage I-III SCLC from January 1998-December 2009 were retrospectively analyzed to elucidate the risk factors of brain metastases. Log-rank test and Cox regression model were used to determine the risk factors of brain metastases. Results: The median survival time for this patient population was 34 months, and the 5-year overall survival rate was 34.9%. For the whole group, 23.0% (29/126) of the patients had evidence of metastases to brain. Pathologic stage not only correlated with overall survival but also significantly affected the risk of brain metastases. The 5-year survival rates for patients with pathologic stages I, II, and III were 54.8%, 35.6%, and 14.1%, respectively (P=.001). The frequency of brain metastases in patients with pathologic stages I, II, and III were 6.25% (2/32), 28.2% (11/39), and 29.1% (16/55) (P=.026), respectively. A significant difference in brain metastases between patients with complete resection and incomplete resection was also observed (20.5% vs 42.9%, P=.028). The frequency of brain metastases was not found to be correlated with age, sex, pathologic type, induction chemotherapy, adjuvant chemotherapy, or adjuvant radiation therapy. Conclusions: Stage I SCLC patients with complete resection had a low incidence of brain metastases and a favorable survival rate. Stage II-III disease had a higher incidence of brain metastases. Thus, PCI might have a role for stage II-III disease but not for stage I disease.

  2. Association between MTHFR C677T, MTHFR A1298C and MS A2756G polymorphisms and risk of cervical intraepithelial neoplasia II/III and cervical cancer: a meta-analysis.

    PubMed

    Zhu, Jie; Wu, Lei; Kohlmeier, Martin; Ye, Fangli; Cai, Wei

    2013-09-01

    Numerous case-control studies on the association between polymorphisms of key genes involved in methionine remethylation [methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MS)] and the susceptibility of cervical intraepithelial neoplasia (CIN) and cervical cancer have provided inconclusive results. The aim of the present meta-analysis was to determine the effects of two MTHFR (C677T and A1298C) and one MS gene polymorphism (A2756G) on the risk of CIN II/III or cervical cancer. Relevant data were retrieved following a systematic search in PubMed, Web of Science, MEDLINE and Wanfang Data up to November 2012. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated from eligible studies by meta-analysis with subgroup analyses stratified by ethnicity. A total of 13 studies with 1,936 cases and 2,858 controls were included in the present meta?analysis. An increased risk of cervical cancer was found in Asian women with the MTHFR 677T allele (TT vs. CC: OR=1.41, 95% CI=1.07?1.86, P=0.01; TT vs. CC+CT: OR=1.38, 95% CI=1.08-1.75, P=0.008), while a decreased risk was observed in Caucasian women (TT vs. CC: OR=0.65, 95% CI=0.45-0.93, P=0.02; TT+CT vs. CC: OR=0.7, 95% CI=0.58-0.86, P=0.0005). No effects of MTHFR C677T polymorphism on CIN II/III risk and MTHFR A1298C or MS A2756G polymorphisms on cervical cancer risk were detected. The sensitivity analysis suggested stability of this meta-analysis and no publication bias was detected. The MTHFR 677T allele may enhance the risk of cervical cancer in the Asian female population and play a protective role in Caucasian females. However, limited association is suggested between MTHFR A1298C and MS A2756G polymorphisms with cervical tumorigenesis. PMID:23864153

  3. [Esophago-bronchial fistula which developed after the insertion of an expandable metallic stent for corrosive esophageal stenosis].

    PubMed

    Tagawa, T; Itoh, S; Ide, S; Tanaka, K; Sumida, Y; Ohe, H

    1997-07-01

    A 69-year-old man attempted suicide by abdominal penetrating injury and taking sulfonyl acid. After a laparotomic drainage operation, corrosive esophageal stenosis occurred. Esophageal bougienage was not effective. An expandable metallic stent (GIANTURCO-ROCHE Z stent, Cook Bloomington U.S.A.) was inserted aiming to achieve temporary oral diet and nutritional improvement. But diet did not improve sufficiently because of the awareness of the prosthesis, severe hiccup, uncontrolled regurgitation esophagitis and restenosis caused by intraluminal mucosal growth. After 4 months of insertion, an esophago-bronchial fistula was produced by the wire of EMS. An operation became necessary for this complication. No data exist on the long-term use of the EMS and it is not suitable for benign esophageal stenosis. Unavoidably if the palliative treatment of endoprosthesis is necessary for benign esophageal stenosis such as corrosive esophageal stenosis, a removable esophageal tube prosthesis is preferable. PMID:9256648

  4. Esophageal leiomyosarcoma: clinical analysis and surgical treatment of 12 cases.

    PubMed

    Zhang, B H; Zhang, H T; Wang, Y G

    2014-08-01

    Leiomyosarcoma of the esophagus is a rare malignant tumor with slow growth and late metastasis. The aim of this study was to reassess the clinical characteristics and treatment modality in one of the largest series of esophageal leiomyosarcomas from a single institution. From February 1973 to December 2011, 12 cases of esophageal leiomyosarcoma were identified. The principal symptoms included progressive dysphagia in 11 cases (91.7%), retrosternal/back pain in four (33.3%), weight loss in four (33.3%), upper gastrointestinal hemorrhage in two (16.7%), and emesis in two (16.7%). The average duration of symptoms was 10.6 months. The location of the primary tumor was in the middle thoracic esophagus in five cases, and lower thoracic esophagus in seven cases. Six cases were classified as the polypoid type, five cases as the infiltrative type, and only one case as the intramural type. All 12 of the patients underwent esophagectomies, and radical resections were achieved in these patients. Based on the Kaplan-Meier Method, the 3-, 5-, and 10-year survival rates were 80.0%, 58.3%, and 31.1%, respectively, with a median survival of 63 months. Five-year survival rates for patients with polypoid or intramural tumors (n = 7) was 83.3%, and for patients with infiltrative tumor (n = 5) it was 25.0%. One of the patients had tumor resected four times and survived for 161 months. In conclusion, patients presenting with esophageal leiomyosarcomas have an excellent prognosis, and radical resection may achieve acceptable results. PMID:23163522

  5. Esophageal Cancer Dose Escalation Using a Simultaneous Integrated Boost Technique

    SciTech Connect

    Welsh, James, E-mail: jwelsh@mdanderson.org [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Palmer, Matthew B. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Liao Zhongxing [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Swisher, Steven G.; Hofstetter, Wayne L. [Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Allen, Pamela K.; Settle, Steven H.; Gomez, Daniel; Likhacheva, Anna; Cox, James D.; Komaki, Ritsuko [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2012-01-01

    Purpose: We previously showed that 75% of radiation therapy (RT) failures in patients with unresectable esophageal cancer are in the gross tumor volume (GTV). We performed a planning study to evaluate if a simultaneous integrated boost (SIB) technique could selectively deliver a boost dose of radiation to the GTV in patients with esophageal cancer. Methods and Materials: Treatment plans were generated using four different approaches (two-dimensional conformal radiotherapy [2D-CRT] to 50.4 Gy, 2D-CRT to 64.8 Gy, intensity-modulated RT [IMRT] to 50.4 Gy, and SIB-IMRT to 64.8 Gy) and optimized for 10 patients with distal esophageal cancer. All plans were constructed to deliver the target dose in 28 fractions using heterogeneity corrections. Isodose distributions were evaluated for target coverage and normal tissue exposure. Results: The 50.4 Gy IMRT plan was associated with significant reductions in mean cardiac, pulmonary, and hepatic doses relative to the 50.4 Gy 2D-CRT plan. The 64.8 Gy SIB-IMRT plan produced a 28% increase in GTV dose and comparable normal tissue doses as the 50.4 Gy IMRT plan; compared with the 50.4 Gy 2D-CRT plan, the 64.8 Gy SIB-IMRT produced significant dose reductions to all critical structures (heart, lung, liver, and spinal cord). Conclusions: The use of SIB-IMRT allowed us to selectively increase the dose to the GTV, the area at highest risk of failure, while simultaneously reducing the dose to the normal heart, lung, and liver. Clinical implications warrant systematic evaluation.

  6. Esophageal gastrointestinal stromal tumor: report of 7 patients

    PubMed Central

    Zukotynski, K.A.; Krajewski, K.M.; Jagannathan, J.P.; Butrynski, J.; Hornick, J.L.; Ramaiya, N.H.

    2012-01-01

    Abstract Abstract Purpose: To evaluate imaging features of esophageal gastrointestinal stromal tumors (GIST) with clinical and histopathologic correlation and imaging follow-up. Materials and methods: In this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, 14 patients with pathologically proven esophageal GIST seen from January 2001 to October 2011, 7 patients (4 women; mean age 70 years, range 56–87 years) who had imaging of primary tumor and follow-up imaging at our institution were included. Imaging studies were evaluated by 3 radiologists in consensus. Location, size and imaging features of primary tumor and metastases, if any, were recorded, and correlated with pathologic (histopathologic subtype, presence of necrosis, mitotic rate, immunohistochemical profile) and clinical (treatment-related changes, distant spread and outcome) parameters. Results: Of 7 tumors, 5 were located in the lower esophagus and 2 in mid-esophagus. Four were intraluminal, 2 were exophytic, and 1 was intramural. All 7 patients underwent computed tomography (CT); tumors appeared as well-circumscribed, hypoattenuating masses showing mild enhancement, with mean size of 5.7?×?4.2?cm. Necrosis and calcification were seen in 1 tumor each. Five patients underwent fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. GISTs were FDG avid with mean standardized uptake value (SUV)max of 9.5 (4.5–12.3). All tumors were positive for KIT (7/7) and CD34 (6/6). Distant metastases to liver and pleura were seen in 1 patient. On imatinib treatment, the tumors responded with decreased attenuation values and unchanged size on CT, and decreased SUVmax of primary tumor and metastases on FDG-PET/CT. Conclusion: Esophageal GISTs are well-circumscribed, FDG-avid, hypoattenuating masses that can metastasize to liver and pleura, and respond to imatinib treatment with decreased attenuation value on CT and decreased SUVmax on FDG-PET/CT. PMID:22542728

  7. Multimodality approach for locally advanced esophageal cancer

    PubMed Central

    Almhanna, Khaldoun; Strosberg, Jonathan R

    2012-01-01

    Carcinoma of the esophagus is an aggressive and lethal malignancy with an increasing incidence worldwide. Incidence rates vary internationally, with the highest rates found in Southern and Eastern Africa and Eastern Asia, and the lowest in Western and Middle Africa and Central America. Patients with locally advanced disease face a poor prognosis, with 5-year survival rates ranging from 15%-34%. Recent clinical trials have evaluated different strategies for management of locoregional cancer; however, because of stage migration and changes in disease epidemiology, applying these trials to clinical practice has become a daunting task. We searched Medline and conference abstracts for randomized studies published in the last 3 decades. We restricted our search to articles published in English. Neoadjuvant chemoradiotherapy followed by surgical resection is an accepted standard of care in the United States. Esophagectomy remains an essential component of treatment and can lead to improved overall survival, especially when performed at high volume institutions. The role of adjuvant chemotherapy following curative resection is still unclear. External beam radiation therapy alone is considered palliative and is typically reserved for patients with a poor performance status. PMID:23155307

  8. Esophageal obstruction and intracardiac "mass" in association with omphalocele closure.

    PubMed

    Victoria, Teresa; Kramer, Sandra S; Markowitz, Richard; Servaes, Sabah; Mong, Andrew; Jaramillo, Diego; Adzick, N Scott

    2009-02-01

    Patients with large omphaloceles are subject to anatomical displacement and morphological distorsion after surgical repair. We report 2 such complications in an infant after repair of a giant omphalocele that contained both liver and bowel. Esophageal obstruction resulted from sharp, anterior angulation of the distal esophagus that hindered placement of a feeding tube in the neonatal period. At 1 year of age, routine cardiac evaluation led to the discovery of a "mass" within the heart caused by invagination of a tongue of liver tissue into the right atrium. Knowledge of these less well-recognized anatomical variations is important to avoid unnecessary interventions. PMID:19231555

  9. Laparoscopic anatomy of the region of the esophageal hiatus

    Microsoft Academic Search

    G. G. R. Kuster; F. A. Innocenti

    1997-01-01

    Background: The wide patient acceptance of hiatal and gastroesophageal surgery performed by laparoscopy has suddenly generated a large\\u000a volume of procedures frequently done by surgeons with limited experience in this area. This has resulted in an excessive number\\u000a of complications. Knowledge of the normal and pathologic laparoscopic anatomy is essential for safe dissection around the\\u000a esophageal hiatus.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a Methods: This description

  10. Esophageal Contractions in Patients with Chronic Progressive External Ophthalmoplegia

    Microsoft Academic Search

    Danielle Ramos Domenis; Paula Macedo Carvalho Issa Okubo; Cláudia Sobreira; Roberto Oliveira Dantas

    2011-01-01

    Background  Chronic progressive external ophthalmoplegia is a mitochondrial myopathy that causes muscular or multisystem symptoms and\\u000a has dysphagia as one manifestation.\\u000a \\u000a \\u000a \\u000a \\u000a Aim  To evaluate esophageal contractions in patients with chronic progressive external ophthalmoplegia.\\u000a \\u000a \\u000a \\u000a Methods  We studied 14 patients with chronic progressive external ophthalmoplegia and 16 asymptomatic volunteers. The diagnosis of\\u000a the disease was established by the clinical picture and by mitochondrial DNA analysis

  11. Bouveret's Syndrome with Severe Esophagitis and a Purulent Fistula

    PubMed Central

    Bonam, Rami; Vahora, Zahid; Leland, William

    2014-01-01

    Bouveret's syndrome is a rare variant of gallstone ileus with an overall incidence of 1–3%. It is a rare cause of gastric outlet obstruction resulting from the passage and impaction of a large gallstone through a cholecysto-duodenal fistula. A combination of diagnostic modalities is often required for a diagnosis. Management options include endoscopy and surgery. The most commonly performed procedures are enterolithotomy or gastrostomy, either alone or with cholecystectomy and fistula repair. We describe a unique variant of chronic Bouveret's syndrome with the unusual associations of severe esophagitis and a purulent fistula.

  12. Echocardiographic Manifestation of Esophagitis Mimicking a Posterior Mediastinal Mass

    PubMed Central

    Swarup, Supreeya; Kantamneni, Sowmya; Kabir, Sarah; Zeltser, Roman; Makaryus, Amgad N

    2014-01-01

    Incidental extracardiac findings (ECFs) are commonly noted on cardiac imaging. The majority of the ECFs are noticed on computed tomography (CT), cardiac magnetic resonance scanning, and myocardial perfusion imaging. Although transthoracic echocardiography (TTE) is a widely used cardiac modality, there is scarcity of data describing ECF on TTE. ECFs have the potential to alter patient management. We present a rare case of a cystic mass seen in the posterior mediastinum on TTE, which led to further evaluation and diagnosis of esophagitis with ulceration. PMID:25780343

  13. Left atrio-esophageal fistula of a possibly iatrogenic aetiology.

    PubMed

    Arkuszewski, Piotr; Barzdo, Maciej; Ostrowski, Stanis?aw; Szram, Stefan; Berent, Jaros?aw

    2015-07-01

    The study presents an exceptionally rare case of an esophago-left atrial fistula, which was diagnosed during a forensic post-mortem examination. Due to complex nature of the disease and many attempts to cure the patient, the authors did not manage to identify the aetiology of the fistula. It was only implied that the fistula might have been a distant complication of intraoperative endocardial ablation or it might have appeared as a consequence of perforation of the esophageal wall or left atrial wall of the enlarged heart with the end of an intubation tube or nasogastric tube. PMID:25952079

  14. Definitive radiotherapy for early-stage hypopharyngeal squamous cell carcinoma.

    PubMed

    Sato, Kaname; Kubota, Akira; Furukawa, Madoka; Kitani, Yousuke; Nakayama, Yuko; Nonaka, Tetsuo; Mizoguchi, Nobutaka; Shiomi, Miho

    2015-08-01

    The present study analyzed the outcomes of patients with early-stage hypopharyngeal squamous cell carcinoma (HPSCC) treated with radical radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). We retrospectively reviewed the clinical records of 33 patients with early-stage HPSCC who underwent RT or CCRT between January 1999 and December 2011. Of the 33 patients who were treated, 12 had Stage I and 21 had Stage II disease. Patients with Stage I were typically treated with RT, while patients with Stage II were treated with CCRT (concurrent chemotherapy: 5FU, cisplatin or TS-1). The median follow-up period was 81 months, ranging from 15 to 155 months. The 5-year overall survival rates, cause specific survival rates, locoregional control rates, and progression-free survival rates were 58, 75, 56, and 49 %, respectively. Of the 33 patients, 51 % experienced second primary malignancies. Esophageal carcinoma occurred in several cases, and was diagnosed either during screening after treatment for the second primary malignancy or simultaneously with the second primary malignancy. Advanced-stage second malignancies significantly influenced the survival of the patients and the control rate for HPSCC. Treatment emphasizing the quality of life after treatment is needed, if a poor prognosis is expected because of advanced-stage second primary malignancy. PMID:24939176

  15. Molecular Changes in Pre-Metastatic Lymph Nodes of Esophageal Cancer Patients

    PubMed Central

    Otto, Benjamin; Koenig, Alexandra M.; Tolstonog, Genrich V.; Jeschke, Anke; Klaetschke, Kristin; Vashist, Yogesh K.; Wicklein, Daniel; Wagener, Christoph; Izbicki, Jakob R.; Streichert, Thomas

    2014-01-01

    Lymph node metastasis indicates poor prognosis in esophageal cancer. To understand the underlying mechanisms, most studies so far focused on investigating the tumors themselves and/or invaded lymph nodes. However they neglected the potential events within the metastatic niche, which precede invasion. Here we report the first description of these regulations in patients on transcription level. We determined transcriptomic profiles of still metastasis-free regional lymph nodes for two patient groups: patients classified as pN1 (n?=?9, metastatic nodes exist) or pN0 (n?=?5, no metastatic nodes exist). All investigated lymph nodes, also those from pN1 patients, were still metastasis-free. The results show that regional lymph nodes of pN1 patients differ decisively from those of pN0 patients – even before metastasis has taken place. In the pN0 group distinct immune response patterns were observed. In contrast, lymph nodes of the pN1 group exhibited a clear profile of reduced immune response and reduced proliferation, but increased apoptosis, enhanced hypoplasia and morphological conversion processes. DKK1 was the most significant gene associated with the molecular mechanisms taking place in lymph nodes of patients suffering from metastasis (pN1). We assume that the two molecular profiles observed constitute different stages of a progressive disease. Finally we suggest that DKK1 might play an important role within the mechanisms leading to lymph node metastasis. PMID:25048826

  16. Clinical parameters model for predicting pathologic complete response following preoperative chemoradiation in patients with esophageal cancer

    PubMed Central

    Ajani, J. A.; Correa, A. M.; Hofstetter, W. L.; Rice, D. C.; Blum, M. A.; Suzuki, A.; Taketa, T.; Welsh, J.; Lin, S. H.; Lee, J. H.; Bhutani, M. S.; Ross, W. A.; Maru, D. M.; Macapinlac, H. A.; Erasmus, J.; Komaki, R.; Mehran, R. J.; Vaporciyan, A. A.; Swisher, S. G.

    2012-01-01

    Background Approximately 25% of patients with esophageal cancer (EC) who undergo preoperative chemoradiation, achieve a pathologic complete response (pathCR). We hypothesized that a model based on clinical parameters could predict pathCR with a high (?60%) probability. Patients and methods We analyzed 322 patients with EC who underwent preoperative chemoradiation. All the patients had baseline and postchemoradiation positron emission tomography (PET) and pre- and postchemoradiation endoscopic biopsy. Logistic regression models were used for analysis, and cross-validation via the bootstrap method was carried out to test the model. Results The 70 (21.7%) patients who achieved a pathCR lived longer (median overall survival [OS], 79.76 months) than the 252 patients who did not achieve a pathCR (median OS, 39.73 months; OS, P = 0.004; disease-free survival, P = 0.003). In a logistic regression analysis, the following parameters contributed to the prediction model: postchemoradiation PET, postchemoradiation biopsy, sex, histologic tumor grade, and baseline EUST stage. The area under the receiver-operating characteristic curve was 0.72 (95% confidence interval [CI] 0.662–0.787); after the bootstrap validation with 200 repetitions, the bias-corrected AU-ROC was 0.70 (95% CI 0.643–0.728). Conclusion Our data suggest that the logistic regression model can predict pathCR with a high probability. This clinical model could complement others (biomarkers) to predict pathCR. PMID:22831985

  17. Notch Signaling Target Genes are Directly Correlated to Esophageal Squamous Cell Carcinoma Tumorigenesis.

    PubMed

    Forghanifard, Mohammad Mahdi; Taleb, Shaghayegh; Abbaszadegan, Mohammad Reza

    2015-04-01

    Notch signaling is an important cellular pathway which affects the development and function of many organs. It plays critical roles in maintaining of progenitor stem cell population as well as balancing cell proliferation, survival, differentiation and apoptosis. It has been shown that notch signaling is aberrantly activated during the carcinogenesis of a variety of human cancers. In this study we aimed to explore activation of this signaling pathway in esophageal squamous cell carcinoma (ESCC) through expressional analysis of notch signaling target genes. The mRNA expression of HEY1and HEY2 was comparatively analyzed by real-time PCR in tumor and related margin normal tissues of 50 ESCC patients. Comparative quantitative real-time PCR indicates the overexpression of HEY1 and HEY2 in 54 and 30 % of ESCC samples, respectively. Overexpression of HEY1 was significantly associated with stage of the tumor (p?=?0.048) and tumor location (p?=?0.008). HEY2 overexpression was also significantly correlated to node metastasis of tumor cells (p?=?0.043). Overexpression of HEY1 and HEY2 in ESCC is correlated to different indices of poor prognosis and it is extrapolated that such overexpression is important in progression and development of ESCC tumorigenesis. To the best of our knowledge, this is the first report introducing aberrant activation of notch signaling target genes in ESCC, where it plays roles in development and progression of the malignancy and may be considered in therapeutic modalities to restrict ESCC progression. PMID:25361534

  18. Seamless vascularized large-diameter tubular collagen scaffolds reinforced with polymer knittings for esophageal regenerative medicine.

    PubMed

    Hoogenkamp, Henk R; Koens, Martin J W; Geutjes, Paul J; Ainoedhofer, Herwig; Wanten, Geert; Tiemessen, Dorien M; Hilborn, Jöns; Gupta, Bhuvanesh; Feitz, Wouter F J; Daamen, Willeke F; Saxena, Amulya K; Oosterwijk, Egbert; van Kuppevelt, Toin H

    2014-05-01

    A clinical demand exists for alternatives to repair the esophagus in case of congenital defects, cancer, or trauma. A seamless biocompatible off-the-shelf large-diameter tubular scaffold, which is accessible for vascularization, could set the stage for regenerative medicine of the esophagus. The use of seamless scaffolds eliminates the error-prone tubularization step, which is necessary when emanating from flat scaffolds. In this study, we developed and characterized three different types of seamless tubular scaffolds, and evaluated in vivo tissue compatibility, including vascularization by omental wrapping. Scaffolds (luminal Ø ? 1.5 cm) were constructed using freezing, lyophilizing, and cross-linking techniques and included (1) single-layered porous collagen scaffold, (2) dual-layered (porous+dense) collagen scaffold, and (3) hybrid scaffold (collagen+incorporated polycaprolacton knitting). The latter had an ultimate tensile strength comparable to a porcine esophagus. To induce rapid vascularization, scaffolds were implanted in the omentum of sheep using a wrapping technique. After 6 weeks of biocompatibility, vascularization, calcification, and hypoxia were evaluated using immunohistochemistry. Scaffolds were biocompatible, and cellular influx and ingrowth of blood vessels were observed throughout the whole scaffold. No calcification was observed, and slight hypoxic conditions were detected only in the direct vicinity of the polymer knitting. It is concluded that seamless large-diameter tubular collagen-based scaffolds can be constructed and vascularized in vivo. Such scaffolds provide novel tools for esophageal reconstruction. PMID:24099067

  19. A TNM Staging System for Nasal NK/T-Cell Lymphoma

    PubMed Central

    Yan, Zheng; Huang, Hui-qiang; Wang, Xiao-xiao; Gao, Yan; Zhang, Yu-jing; Bai, Bing; Zhao, Wei; Jiang, Wen-qi; Li, Zhi-ming; Xia, Zhong-jun; Lin, Su-xia; Xie, Chuan-miao

    2015-01-01

    Ann Arbor stage has limited utility in the prognostication and treatment decision making in patients with NK/T-cell lymphoma (NKTCL), as NKTCL is almost exclusively extranodal and the majority is localized at presentation for which radiotherapy is the most important treatment and local invasiveness is the most important prognostic factor. In this study, we attempted to establish a TNM (Tumor-Node-Metastasis) staging system for nasal NKTCL (N-NKTCL). The staging rules of other head and neck cancers were used as reference along with the data of our 271 eligible patients. The primary tumor was classified into T1 to T4, and cervical lymph node metastasis was classified into N0 to N2 according to the extent of involvement. Any lesions outside the head and neck were classified as M1. N-NKTCL thereby was classified into four stages: stage I comprised T1-2N0M0; stage II comprised T1-2N1M0 and T3N0M0; stage III comprised T3N1M0, T1-3N2M0, and T4N0-2M0; and stage IV comprised TanyNanyM1. This staging system showed excellent performance in prognosticating survival. In the current series, the 5-year survival rates of patients with stages I, II, III, and IV N-NKTCL were 92%, 64%, 23%, and 0, respectively. Moreover, the predictive value of several currently used factors was abrogated in the presence of the TNM stage. The TNM staging system is highly effective in stratifying tumor burden and survival risk, which may have significant implications in the treatment decision making for patients with N-NKTCL. PMID:26098892

  20. Identification of signature genes for detecting hedgehog pathway activation in esophageal cancer

    PubMed Central

    Yang, Ling; Bian, Yuehong; Huang, Shuhong; Ma, Xiaoli; Zhang, Chi; Su, Xiulan; Chen, Zi-Jiang; Xie, Jingwu; Zhang, Hongwei

    2011-01-01

    The hedgehog signaling pathway plays an important role in cell growth and differentiation both in normal embryonic development and in tumors. Our previous work shows that hedgehog pathway is frequently activated in esophageal cancers. To further elucidate the role of hedgehog pathway in esophageal cancers we examined the expression of the target genes, hedgehog-interacting protein (HIP) and platelet derived growth factor receptor alpha (PDGFR?) and hedgehog signaling molecules, smoothened (SMO), suppressor of fused (Su(Fu)) in the specimens using in situ hybridization and RT-PCR. We found that HIP, PDGFR?, SMO and Su(Fu) gene highly expressed in the primary esophageal squamous cell carcinomas but not in normal esophageal tissue. The transcripts of HIP, PDGFR? and SMO were expressed in 13 of 15 esophageal cancers. Su(Fu) expression was missing in 2 esophageal cancers. The results from in-situ hybridization were further confirmed by RT-PCR. Our results revealed a set of genes for detecting hedgehog signaling activation in esophageal cancer. PMID:21210262